Provider Demographics
NPI:1306281522
Name:SANTA-CRUZ, RAYMOND A (DMD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:SANTA-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 1:4104 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1721
Mailing Address - Country:US
Mailing Address - Phone:727-376-2666
Mailing Address - Fax:727-245-8864
Practice Address - Street 1:4104 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1721
Practice Address - Country:US
Practice Address - Phone:727-376-2666
Practice Address - Fax:727-245-8864
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20079332B00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies