Healthcare Provider Details

I. General information

NPI: 1356822647
Provider Name (Legal Business Name): YEVAH NICOLE CUETO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7451 103RD ST STE 18
JACKSONVILLE FL
32210-6789
US

IV. Provider business mailing address

4454 GLEN KERNAN PKWY E
JACKSONVILLE FL
32224-5626
US

V. Phone/Fax

Practice location:
  • Phone: 904-777-4622
  • Fax:
Mailing address:
  • Phone: 904-866-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN23605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: