Jennifer R. Park-Cruz Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

51126 Issued in CA

Legal business name

JENNIFER R. PARK-CRUZ DENTAL CORPORATION

Doing business as

Wilshire Dental Group

Practice address

2975 Wilshire Blvd
#400
Los Angeles, CA 90010-1107

Phone

(213) 385-0053

NPI assigned

Oct 5, 2007

Last updated

Oct 5, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer R. Park-Cruz, D.D.S.NPI 1073059861

Title

President

Phone

(213) 385-0053

Specialties & licenses 1

Addresses

Other names 1

• Wilshire Dental Group Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Park-Cruz, DR

  • General Practice Dentistry
  • Los Angeles, CA
  • NPI 1073059861
  NPD (past) Authorized official

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191542400000",
    "number": "1396933289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 WILSHIRE BLVD",
            "address_2": "#400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101107",
            "telephone_number": "213-385-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 WILSHIRE BLVD",
            "address_2": "#400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101107",
            "telephone_number": "213-385-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER R. PARK-CRUZ DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-05",
        "last_updated": "2007-10-05",
        "status": "A",
        "authorized_official_last_name": "PARK-CRUZ",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-385-0053",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "51126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilshire Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; 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.