Provider Demographics
NPI:1558450957
Name:DE LA CRUZ, MICHAEL LUNA JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LUNA
Last Name:DE LA CRUZ
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12085 HEACOCK ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-7102
Mailing Address - Country:US
Mailing Address - Phone:951-486-9179
Mailing Address - Fax:951-486-9527
Practice Address - Street 1:12085 HEACOCK ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7102
Practice Address - Country:US
Practice Address - Phone:951-486-9179
Practice Address - Fax:951-486-9527
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice