Provider Demographics
NPI:1528377546
Name:DELLA CROCE, JOHN NEIL (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NEIL
Last Name:DELLA CROCE
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8070 SW HALL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6419
Mailing Address - Country:US
Mailing Address - Phone:503-644-1110
Mailing Address - Fax:
Practice Address - Street 1:8070 SW HALL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6419
Practice Address - Country:US
Practice Address - Phone:503-644-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0384681223G0001X
ORD10465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice