Healthcare Provider Details

I. General information

NPI: 1659800720
Provider Name (Legal Business Name): TRICIA MAE CUEVA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MLK JR BLVD
WICHITA FALLS TX
76301-1152
US

IV. Provider business mailing address

200 MLK JR BLVD
WICHITA FALLS TX
76301-1152
US

V. Phone/Fax

Practice location:
  • Phone: 940-766-6306
  • Fax:
Mailing address:
  • Phone: 940-766-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7052
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32946
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32946
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: