Provider Demographics
NPI:1588297329
Name:DANIEL N DELA CRUZ DMD PLLC
Entity type:Organization
Organization Name:DANIEL N DELA CRUZ DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:NIEL
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, BSN
Authorized Official - Phone:775-722-4823
Mailing Address - Street 1:15409 W GREENWAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4368
Mailing Address - Country:US
Mailing Address - Phone:623-546-3511
Mailing Address - Fax:
Practice Address - Street 1:15409 W GREENWAY RD STE 100
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4368
Practice Address - Country:US
Practice Address - Phone:623-546-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty