Healthcare Provider Details

I. General information

NPI: 1407905680
Provider Name (Legal Business Name): MARCO ANTONIO CUEVA D.D.S.,M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 W MCDERMOTT DR SUITE 200
ALLEN TX
75013-2817
US

IV. Provider business mailing address

1511 W MCDERMOTT DR SUITE 200
ALLEN TX
75013-2817
US

V. Phone/Fax

Practice location:
  • Phone: 972-390-9944
  • Fax: 972-390-9190
Mailing address:
  • Phone: 972-390-9944
  • Fax: 972-390-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number21478
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: