Provider Demographics
NPI:1235953191
Name:CRUZ GONZALVEZ, PABLO (RDH)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:CRUZ GONZALVEZ
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 N POWERLINE RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-2514
Mailing Address - Country:US
Mailing Address - Phone:954-970-7067
Mailing Address - Fax:954-966-3320
Practice Address - Street 1:162 N POWERLINE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-2514
Practice Address - Country:US
Practice Address - Phone:954-970-7067
Practice Address - Fax:954-966-3320
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH32941124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist