Provider Demographics
NPI:1558511030
Name:DELACRUZ, NICHOLAS PRESTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:PRESTON
Last Name:DELACRUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 WHITLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-2327
Mailing Address - Country:US
Mailing Address - Phone:559-992-5020
Mailing Address - Fax:
Practice Address - Street 1:1209 WHITLEY AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2327
Practice Address - Country:US
Practice Address - Phone:559-992-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist