Provider Demographics
NPI:1992203376
Name:DE JESUS, DULCE (DDS)
Entity type:Individual
Prefix:DR
First Name:DULCE
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 E US HIGHWAY 80
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126
Mailing Address - Country:US
Mailing Address - Phone:469-703-8030
Mailing Address - Fax:469-703-8031
Practice Address - Street 1:557 E US HIGHWAY 80
Practice Address - Street 2:SUITE 130
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126
Practice Address - Country:US
Practice Address - Phone:469-703-8030
Practice Address - Fax:469-703-8031
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1114513256OtherNPI
TX1396331435OtherNPI
TX1992203376OtherNPI