MEDICARE: ERICK N. CUENCA DMD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1518177682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERICK N. CUENCA DMD INC

Provider Business Mailing Address
First Line	:	591 WATT AVE STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95864-5027
Country	:	US
Telephone Number	:	916-481-5057
Fax Number	:

Provider Business Practice Location Address
First Line	:	591 WATT AVE STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95864-5027
Country	:	US
Telephone Number	:	916-481-5057
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ERICK N CUENCA
Credential	:	DMD
Telephone Number	:	714-428-1200

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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