Provider Demographics
NPI:1710007257
Name:DELACRUZ, JOSE R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:DELACRUZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 NW 10TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1313
Mailing Address - Country:US
Mailing Address - Phone:561-395-3443
Mailing Address - Fax:
Practice Address - Street 1:1590 NW 10TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1313
Practice Address - Country:US
Practice Address - Phone:561-395-3443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN81411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice