Healthcare Provider Details

I. General information

NPI: 1578012076
Provider Name (Legal Business Name): OSCAR CUELLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2016
Last Update Date: 09/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 SOUTH BLVD
HOUSTON TX
77006-6338
US

IV. Provider business mailing address

1626 SOUTH BLVD
HOUSTON TX
77006-6338
US

V. Phone/Fax

Practice location:
  • Phone: 713-805-6225
  • Fax:
Mailing address:
  • Phone: 713-805-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32185
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: