Healthcare Provider Details

I. General information

NPI: 1679869176
Provider Name (Legal Business Name): DANIELA CUADRA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 ST LAWRENCE DR SUITE 109
TIFFIN OH
44883-8312
US

IV. Provider business mailing address

27 ST LAWRENCE DR SUITE 109
TIFFIN OH
44883-8312
US

V. Phone/Fax

Practice location:
  • Phone: 419-447-7337
  • Fax:
Mailing address:
  • Phone: 419-447-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30-024396
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: