Healthcare Provider Details

I. General information

NPI: 1134708290
Provider Name (Legal Business Name): GISSELLE CUEVILLAS GUERRA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 WILES RD STE 101
CORAL SPRINGS FL
33067-4105
US

IV. Provider business mailing address

9452 NW 120TH ST APT 522
HIALEAH GARDENS FL
33018-4010
US

V. Phone/Fax

Practice location:
  • Phone: 954-972-7827
  • Fax:
Mailing address:
  • Phone: 786-521-7355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28360
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: