Individual
MARISSA CRANDALL CRUZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D., M.S
Contact information
Practice address
26540 ACE AVE, LEESBURG, FL 34748-8279
(352) 326-4404
Mailing address
949 N 14TH ST, LEESBURG, FL 34748-3838
(352) 460-0164
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS039658
PA
1223P0300X
Periodontics
Primary
DN23797
FL
Other
Enumeration date
12/16/2014
Last updated
12/17/2019
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