Provider Demographics
NPI:1114900198
Name:CRUZ DALECCIO, IRIS MIRTA (DDS)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:MIRTA
Last Name:CRUZ DALECCIO
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 1:9115 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2302
Mailing Address - Country:US
Mailing Address - Phone:305-595-9556
Mailing Address - Fax:305-595-1926
Practice Address - Street 1:9115 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2302
Practice Address - Country:US
Practice Address - Phone:305-595-9556
Practice Address - Fax:305-595-1926
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13911122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist