Provider Demographics
NPI:1154809598
Name:DELA CRUZ, DOMINIQUE CARREON (DMD)
Entity type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:CARREON
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 W FLAMINGO RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2338
Mailing Address - Country:US
Mailing Address - Phone:702-364-2373
Mailing Address - Fax:
Practice Address - Street 1:5670 W FLAMINGO RD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2338
Practice Address - Country:US
Practice Address - Phone:702-364-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-28
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist