Marissa Crandall Cruz, D.M.D., M.S

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN23797 Issued in FL

Practice address

26540 Ace Ave
Leesburg, FL 34748-8279

Phone

(352) 326-4404

NPI assigned

Dec 16, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1418688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1194123638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "949 N 14TH ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347483838",
            "telephone_number": "352-460-0164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26540 ACE AVE",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347488279",
            "telephone_number": "352-326-4404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRANDALL CRUZ",
        "first_name": "MARISSA",
        "credential": "D.M.D., M.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-12-16",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039658",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN23797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Leesburg, FL
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.