Pablo Alexander De la Cruz, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

060722 Issued in NY

Practice address

225 Phoebe LN
Delhi, NY 13753

Phone

(607) 746-3555

NPI assigned

May 14, 2018

Reactivated

Sep 17, 2019

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

• Alex De la Cruz Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 18, 2019.

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568764800000",
    "number": "1225528516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 PHOEBE LN",
            "city": "DELHI",
            "state": "NY",
            "postal_code": "137533468",
            "telephone_number": "607-746-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 PHOEBE LN",
            "city": "DELHI",
            "state": "NY",
            "postal_code": "13753",
            "telephone_number": "607-746-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA CRUZ",
        "first_name": "PABLO",
        "middle_name": "ALEXANDER",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-14",
        "last_updated": "2019-09-18",
        "deactivation_date": "2019-09-03",
        "reactivation_date": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "060722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEX",
            "last_name": "DE LA CRUZ",
            "credential": "DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kathryn Tietz Burud, OTR/L
• Jennice Chrisman
• Amanda Cipperly, M.S. CCC-SLP
• Kelly L Coons
• Mursaleen Nazir Dar, MD
• Jessica Lynn Decker, RN
• Delaware County
• Delaware County Office for the Aging
• Delaware County Public Health Services
• Delaware County Public Health Services

• All providers in Delhi, NY
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.