Active NPI
Stephanie Ann Cruz, DMD
- Periodontics
- San Antonio, TX
National Provider Identifier
1962173864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 40847
- Practice address
- 11019 Culebra Rd Ste 162
San Antonio, TX 78253-4519 - Phone
- (956) 489-2148
- NPI assigned
- Sep 22, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 40847 | TX | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
11019 Culebra Rd Ste 162
San Antonio, TX 78253-4519
Mailing address
2057 Quito Loop
Laredo, TX 78045-6422
Phone (956) 489-2148
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 |
|---|---|---|---|
| 40847 | TX | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722988800000",
"number": "1962173864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2057 QUITO LOOP",
"city": "LAREDO",
"state": "TX",
"postal_code": "780456422",
"telephone_number": "956-489-2148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11019 CULEBRA RD STE 162",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782534519",
"telephone_number": "956-489-2148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZ",
"first_name": "STEPHANIE",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-22",
"last_updated": "2024-08-07",
"certification_date": "2024-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "40847",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.