Provider Demographics
NPI:1073213708
Name:PEREZ DE LA CRUZ, SANDRA (DMD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PEREZ DE LA 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 1:15000 PORTOFINO CIR APT 117
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1250
Mailing Address - Country:US
Mailing Address - Phone:201-397-7359
Mailing Address - Fax:
Practice Address - Street 1:13889 WELLINGTON TRCE STE A5
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8587
Practice Address - Country:US
Practice Address - Phone:201-397-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN28582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program