Provider Demographics
NPI:1861052151
Name:CRUZ, ANDRES MANUEL (DMD)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:MANUEL
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 SW 88TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4149
Mailing Address - Country:US
Mailing Address - Phone:305-310-5644
Mailing Address - Fax:
Practice Address - Street 1:6839 COLLIER BLVD STE 103
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-3632
Practice Address - Country:US
Practice Address - Phone:239-465-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN242731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN24273OtherFLORIDA LICENSE NUMBER