Provider Demographics
NPI:1285611087
Name:DE LA CRUZ, ULISES C (DDS)
Entity type:Individual
Prefix:DR
First Name:ULISES
Middle Name:C
Last Name:DE LA CRUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LONE STAR PASS BLDG 46
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78264-3650
Mailing Address - Country:US
Mailing Address - Phone:210-263-5749
Mailing Address - Fax:210-263-5752
Practice Address - Street 1:1 LONE STAR PASS BLDG 46
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78264-3650
Practice Address - Country:US
Practice Address - Phone:210-263-5749
Practice Address - Fax:210-263-5752
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV03671Medicare UPIN
TX8D1837Medicare ID - Type Unspecified