Provider Demographics
NPI:1467981332
Name:DELA CRUZ, DANIEL NIEL (DMD, BSN)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:NIEL
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:DMD, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 W BASELINE RD STE 131
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7331
Mailing Address - Country:US
Mailing Address - Phone:602-903-2382
Mailing Address - Fax:
Practice Address - Street 1:5030 W BASELINE RD STE 131
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7331
Practice Address - Country:US
Practice Address - Phone:602-903-2382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0097301223G0001X
NV69071223G0001X
AZD086231701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice