Provider Demographics
NPI:1194817254
Name:CRUZ, MARK A (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:32241 CROWN VALLEY PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3310
Mailing Address - Country:US
Mailing Address - Phone:949-661-1006
Mailing Address - Fax:949-661-9454
Practice Address - Street 1:32241 CROWN VALLEY PARKWAY
Practice Address - Street 2:#200
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629
Practice Address - Country:US
Practice Address - Phone:949-661-1006
Practice Address - Fax:949-661-9454
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist