Healthcare Provider Details

I. General information

NPI: 1831911585
Provider Name (Legal Business Name): DE LA CRUZ DENTAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 POTRERO AVE
SUNNYVALE CA
94085
US

IV. Provider business mailing address

5500 MARYLAND WAY
BRENTWOOD TN
37027
US

V. Phone/Fax

Practice location:
  • Phone: 888-926-9385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ULISES DE LA CRUZ
Title or Position: PRESIDENT
Credential: DDS
Phone: 210-263-5700