Provider Demographics
NPI:1538233093
Name:CRUZ AGUSTIN, MARIA A (DDS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:CRUZ AGUSTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 S GROVE AVE
Mailing Address - Street 2:STE. 106 A
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-5693
Mailing Address - Country:US
Mailing Address - Phone:909-930-1197
Mailing Address - Fax:909-930-1233
Practice Address - Street 1:1950 S GROVE AVE
Practice Address - Street 2:STE. 106 A
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-5693
Practice Address - Country:US
Practice Address - Phone:909-930-1197
Practice Address - Fax:909-930-1233
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice