Healthcare Provider Details

I. General information

NPI: 1487081519
Provider Name (Legal Business Name): MARIA CAROLINA CUEVAS-NUNEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 LACEY RD
DOWNERS GROVE IL
60515-5430
US

IV. Provider business mailing address

555 31ST ST SUITE 211-R
DOWNERS GROVE IL
60515-1235
US

V. Phone/Fax

Practice location:
  • Phone: 630-743-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL12079
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number136000206
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number019-031959
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number019-031959
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: