Provider Demographics
NPI:1245406768
Name:DELACRUZ, LIZABETH FANEGA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIZABETH
Middle Name:FANEGA
Last Name:DELACRUZ
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:PO BOX 3538
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-3538
Mailing Address - Country:US
Mailing Address - Phone:970-328-1075
Mailing Address - Fax:
Practice Address - Street 1:11 EAGLE PARK DRIVE EAST
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-8163
Practice Address - Country:US
Practice Address - Phone:970-328-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206241223G0001X
CO202989122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice