=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275474801
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN DENTAL WELLNESS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2026
-----------------------------------------------------
Last Update Date | 04/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38 BLANDING BLVD STE A
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32073-2282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-272-9440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6960 BONNEVAL RD STE 102
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-4045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-616-8253
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | MRS. YEVAH CUETO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 904-616-8253
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------