Provider Demographics
NPI:1902057979
Name:DE LA CRUZ, CAROLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLA
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 DODONA TER STE 105A
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4709
Mailing Address - Country:US
Mailing Address - Phone:571-293-0244
Mailing Address - Fax:
Practice Address - Street 1:1509 DODONA TER
Practice Address - Street 2:SUITE 105A
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4709
Practice Address - Country:US
Practice Address - Phone:571-293-0244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014129201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry