Healthcare Provider Details

I. General information

NPI: 1891719597
Provider Name (Legal Business Name): PEDRO JOSE CUARTAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 VALHI BLVD
HOUMA LA
70360
US

IV. Provider business mailing address

600 VALHI BLVD
HOUMA LA
70360-5976
US

V. Phone/Fax

Practice location:
  • Phone: 985-872-3677
  • Fax: 985-872-3680
Mailing address:
  • Phone: 985-872-3677
  • Fax: 985-872-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5237
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: