Provider Demographics
NPI:1275777112
Name:DE LA CRUZ, EILEEN O (DMD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:O
Last Name: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 1:33 BARKER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1635
Mailing Address - Country:US
Mailing Address - Phone:914-328-8960
Mailing Address - Fax:
Practice Address - Street 1:33 BARKER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1635
Practice Address - Country:US
Practice Address - Phone:914-328-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist