Healthcare Provider Details

I. General information

NPI: 1255265245
Provider Name (Legal Business Name): JACOB SAMUEL CUEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 W LAWRENCE AVE
CHARLOTTE MI
48813-1326
US

IV. Provider business mailing address

790 W LAWRENCE AVE
CHARLOTTE MI
48813-1326
US

V. Phone/Fax

Practice location:
  • Phone: 517-543-3143
  • Fax:
Mailing address:
  • Phone: 517-543-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603175
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: