Active NPI
Jessica Louise de Jesus Cruz, DMD
- General Practice Dentistry
- Modesto, CA
National Provider Identifier
1508697962
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 110479
- Practice address
- 1524 McHenry Ave Ste 365
Modesto, CA 95350-4568 - Phone
- (209) 578-5035
- NPI assigned
- Aug 8, 2024
- Last updated
- Aug 8, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 110479 | CA | Primary |
Addresses
Primary practice location
1524 McHenry Ave Ste 365
Modesto, CA 95350-4568
Mailing address
2655 Henley Pkwy Unit 6311
Tracy, CA 95377-2253
Phone (510) 565-8445
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110479 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chet L Jenkins DDS Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Advantage Dental Granite Bay
- Dental Clinic/Center
- San Diego, CA
- NPI 1578202503
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723075200000",
"number": "1508697962",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2655 HENLEY PKWY UNIT 6311",
"city": "TRACY",
"state": "CA",
"postal_code": "953772253",
"telephone_number": "510-565-8445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1524 MCHENRY AVE STE 365",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504568",
"telephone_number": "209-578-5035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZ",
"first_name": "JESSICA",
"middle_name": "LOUISE DE JESUS",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-08",
"last_updated": "2024-08-08",
"certification_date": "2024-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "110479",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.