Provider Demographics
NPI:1609610773
Name:DE LA CRUZ, SARAH LYNN (DDS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LYNN
Other - Last Name:CANADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2015 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1634
Mailing Address - Country:US
Mailing Address - Phone:319-230-0568
Mailing Address - Fax:
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-554-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014509A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice