Jon E Cruz, DDS
Individual provider Active NPI General Practice Dentistry · Pine City, MN
NPI 1720063589 · NPPES record last updated Aug 7, 2013
Key facts
- NPI
- 1720063589
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 11488 (MN)
- Practice address
- 505 Johnson Ave SE
Pine City, MN 55063-2108 - Phone
- (320) 629-2282
- Fax
- (320) 629-3357
- NPI assigned
- Dec 14, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171214000290 | WI | Order and Referring Only - Dentist |
7810255106 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11488 | MN | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11488 | MN | Yes |
Addresses
Primary practice location
505 Johnson Ave SE
Pine City, MN 55063-2108
Mailing address
505 Johnson Ave SE
Pine City, MN 55063-2108
Phone (320) 629-2282
Other providers in Pine City, MN
- Kendall Clevenger
- Community Supports Programming Services LLC
- Community Supports Programming Services LLC
- County of Pine
- Bryan Cropper
- Clay Macklin Danielson
- Mitchell Lee Demers
- Christopher Allen Dockter
- Dr. Shirola & Associates, Optometrists P.a.
- McKayla Rose Duesler
All providers in Pine City, MN · General Practice Dentistry in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.