Healthcare Provider Details

I. General information

NPI: 1801954193
Provider Name (Legal Business Name): HERBERT IVAN CUETO D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8392 W THUNDERBIRD RD
PEORIA AZ
85381-5635
US

IV. Provider business mailing address

10440 E CORTEZ DR
SCOTTSDALE AZ
85259-2936
US

V. Phone/Fax

Practice location:
  • Phone: 623-776-0700
  • Fax:
Mailing address:
  • Phone: 480-704-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD6880
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: