Provider Demographics
NPI:1467981332
Name:DELA CRUZ, DANIEL NIEL (DMD, BSN)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:NIEL
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:DMD, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15409 W GREENWAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4368
Mailing Address - Country:US
Mailing Address - Phone:623-546-3511
Mailing Address - Fax:
Practice Address - Street 1:15409 W GREENWAY RD STE 100
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4368
Practice Address - Country:US
Practice Address - Phone:623-546-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV69071223G0001X
AZD086231701223G0001X
AZD0097301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice