Provider Demographics
NPI:1023417219
Name:DELA CRUZ, RYAN RAY RABAGO (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN RAY
Middle Name:RABAGO
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2551 SAN RAMON VALLEY BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1661
Mailing Address - Country:US
Mailing Address - Phone:925-309-4539
Mailing Address - Fax:925-309-4736
Practice Address - Street 1:2551 SAN RAMON VALLEY BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1661
Practice Address - Country:US
Practice Address - Phone:925-309-4539
Practice Address - Fax:925-309-4736
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63758122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist