Provider Demographics
NPI:1205211364
Name:RYAN RAY DELA CRUZ DDS INC
Entity type:Organization
Organization Name:RYAN RAY DELA CRUZ DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-309-4539
Mailing Address - Street 1:2551 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1614
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
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1614
Practice Address - Country:US
Practice Address - Phone:925-309-4539
Practice Address - Fax:925-309-4736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA637581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty