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General NPI Number Information
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NPI Number | 1407244056
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Entity Type | Organization
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Legal Business Name | MARIA A CUESTA , DMD, PC
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 90 WASHINGTON ST SUITE 209
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City | EAST ORANGE
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State | NJ
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Zip | 07017-1050
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Country | US
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Telephone | 973-414-9015
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Fax | 973-414-9020
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Provider Business Mailing Address
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Address Line | 90 WASHINGTON ST SUITE 209
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City | EAST ORANGE
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State | NJ
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Zip | 07017-1050
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Country | US
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Telephone | 973-414-9015
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Fax | 973-414-9020
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIA A CUESTA
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Credential | DMD
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Telephone | 973-414-9015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DI15274
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License Number State | NJ
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