Provider Demographics
NPI:1003960642
Name:ALEJANDRO DE LA CRUZ DDS
Entity Type:Organization
Organization Name:ALEJANDRO DE LA CRUZ DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-441-2773
Mailing Address - Street 1:7380 BIRD RD STE B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6634
Mailing Address - Country:US
Mailing Address - Phone:305-441-2773
Mailing Address - Fax:305-441-1529
Practice Address - Street 1:7380 BIRD RD STE B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6634
Practice Address - Country:US
Practice Address - Phone:305-441-2773
Practice Address - Fax:305-441-1529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0014560261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070376100Medicaid