Healthcare Provider Details

I. General information

NPI: 1689507469
Provider Name (Legal Business Name): MEGAN CUELLAR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 12TH ST
RICHMOND VA
23298-5064
US

IV. Provider business mailing address

1965 LEMONWOOD RD
CHESAPEAKE VA
23323-5327
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9190
  • Fax:
Mailing address:
  • Phone: 757-287-5604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420073
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: