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General NPI Number Information
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NPI Number | 1730647900
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Entity Type | Individual
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Provider Name | WILLAN FRANCISCO JUMBO CUEVA DMD
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Gender | Male
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 111 E 210TH ST
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City | BRONX
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State | NY
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Zip | 10467-2401
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Country | US
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Telephone | 718-920-4321
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Fax |
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Provider Business Mailing Address
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Address Line | 157 DELANCY ST
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City | NEWARK
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State | NJ
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Zip | 07105-1923
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Country | US
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Telephone |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 13386
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI02891100
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License Number State | NJ
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