Provider Demographics
NPI:1245267947
Name:CRUZ, INGRID (DMD)
Entity type:Individual
Prefix:DR
First Name:INGRID
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:INGRID
Other - Middle Name:
Other - Last Name:PUIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 360650
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0650
Mailing Address - Country:US
Mailing Address - Phone:787-781-9511
Mailing Address - Fax:787-720-3192
Practice Address - Street 1:45 CALLE 8 SUITE 14
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1766
Practice Address - Country:US
Practice Address - Phone:787-781-9511
Practice Address - Fax:787-720-3192
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660672868OtherEMPLOYER IDENTIFICATION #