Healthcare Provider Details

I. General information

NPI: 1003244005
Provider Name (Legal Business Name): CHELSEY KATHERINE CUETO D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 FRANK AVE NW
NORTH CANTON OH
44720-8412
US

IV. Provider business mailing address

8839 SCOTSLANDING CIR NW
MASSILLON OH
44646-1207
US

V. Phone/Fax

Practice location:
  • Phone: 330-806-8763
  • Fax:
Mailing address:
  • Phone: 330-806-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30-023726
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: