Healthcare Provider Details

I. General information

NPI: 1992821359
Provider Name (Legal Business Name): LILIANA CUERVO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18536 OFFICE PARK DR
MONTGOMERY VILLAGE MD
20886-0586
US

IV. Provider business mailing address

18536 OFFICE PARK DR
MONTGOMERY VILLAGE MD
20886-0586
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-5437
  • Fax: 301-869-5433
Mailing address:
  • Phone: 301-564-3075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11837
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: