Healthcare Provider Details

I. General information

NPI: 1710731146
Provider Name (Legal Business Name): ALEJANDRA DE LA CRUZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 DON PASQUAL RD NW
LOS LUNAS NM
87031-8841
US

IV. Provider business mailing address

MSC06 3500 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-8740
  • Fax:
Mailing address:
  • Phone: 505-925-4031
  • Fax: 505-925-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDB20250079
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: