Healthcare Provider Details

I. General information

NPI: 1831651553
Provider Name (Legal Business Name): ALEXA CUESTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAUREL OAK RD
VOORHEES NJ
08043-3512
US

IV. Provider business mailing address

70 TIMBERLINE DR
VOORHEES NJ
08043-3434
US

V. Phone/Fax

Practice location:
  • Phone: 856-783-5777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03084800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberGI-0011536
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: