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General NPI Number Information
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NPI Number | 1356822647
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Entity Type | Individual
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Provider Name | YEVAH NICOLE CUETO DMD
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Gender | Female
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 7451 103RD ST STE 18
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City | JACKSONVILLE
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State | FL
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Zip | 32210-6789
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Country | US
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Telephone | 904-777-4622
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Fax |
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Provider Business Mailing Address
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Address Line | 4454 GLEN KERNAN PKWY E
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City | JACKSONVILLE
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State | FL
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Zip | 32224-5626
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Country | US
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Telephone | 904-866-9144
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN23605
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License Number State | FL
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