Healthcare Provider Details

I. General information

NPI: 1215754122
Provider Name (Legal Business Name): CARMEN CUELLO DE GARCIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W 46TH ST STE 1401
NEW YORK NY
10036-4515
US

IV. Provider business mailing address

10 W 46TH ST STE 1401
NEW YORK NY
10036-4515
US

V. Phone/Fax

Practice location:
  • Phone: 212-759-5595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number064296
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: