NPIMap

Organization Active NPI

Ingrid Mack Cruz DDS a Professional Dental Corporation

  • General Practice Dentistry
  • Ontario, CA
National Provider Identifier
1114206828
Registry record updated Apr 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
53243 Issued in CA
Legal business name
INGRID MACK CRUZ DDS A PROFESSIONAL DENTAL CORPORATION
Practice address
2598 S Archibald Ave Ste C
Ontario, CA 91761-6500
Phone
(909) 947-0670
Fax
(909) 999-8089
NPI assigned
Aug 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ingrid Mack Cruz
Title
Dentist
Phone
(909) 947-0670

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 53243 CA Primary

Addresses

Primary practice location

2598 S Archibald Ave Ste C
Ontario, CA 91761-6500

Mailing address

2598 S Archibald Ave Ste C
Ontario, CA 91761-6500
Phone (909) 947-0670

National Provider Directory

National Provider Directory

Locations

2598 S Archibald Ave
Ste C
Ontario, CA 91761
Phone (909) 947-0670

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461110400000",
    "number": "1114206828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2598 S ARCHIBALD AVE STE C",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917616500",
            "telephone_number": "909-947-0670",
            "fax_number": "909-673-0527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2598 S ARCHIBALD AVE STE C",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917616500",
            "telephone_number": "909-947-0670",
            "fax_number": "909-999-8089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INGRID MACK CRUZ DDS A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-11",
        "last_updated": "2016-04-20",
        "status": "A",
        "authorized_official_last_name": "MACK CRUZ",
        "authorized_official_first_name": "INGRID",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "909-947-0670",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "53243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.