Provider Demographics
NPI:1194280545
Name:OLIVER S. CRUZ, DDS, INC.
Entity type:Organization
Organization Name:OLIVER S. CRUZ, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:SILVESTRE
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-594-4902
Mailing Address - Street 1:5825 LINCOLN AVE STE H
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3477
Mailing Address - Country:US
Mailing Address - Phone:714-761-1736
Mailing Address - Fax:714-761-7179
Practice Address - Street 1:5825 LINCOLN AVE STE H
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3477
Practice Address - Country:US
Practice Address - Phone:714-761-1736
Practice Address - Fax:714-761-1736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental