Provider Demographics
NPI:1346767019
Name:CRUZ, OSMAN JOSSUEL (DDS)
Entity type:Individual
Prefix:
First Name:OSMAN
Middle Name:JOSSUEL
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4392 STURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3674
Mailing Address - Country:US
Mailing Address - Phone:717-564-1681
Mailing Address - Fax:
Practice Address - Street 1:4392 STURBRIDGE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3674
Practice Address - Country:US
Practice Address - Phone:717-564-1681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0420841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice