Healthcare Provider Details

I. General information

NPI: 1609576800
Provider Name (Legal Business Name): JEWELYN KRISTEL DELA CRUZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15213 SW 127TH AVE STE 3
MIAMI FL
33177-1461
US

IV. Provider business mailing address

15213 SW 127TH AVE STE 3
MIAMI FL
33177-1461
US

V. Phone/Fax

Practice location:
  • Phone: 786-870-4805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31654
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: