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General NPI Number Information
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NPI Number | 1750450052
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Entity Type | Organization
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Legal Business Name | COSMOPOLITAN DENTISTRY
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 225 ABERDEEN DR SUITE E
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City | VALPARAISO
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State | IN
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Zip | 46385-7762
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Country | US
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Telephone | 219-548-2322
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Fax | 312-577-0841
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Provider Business Mailing Address
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Address Line | 225 ABERDEEN DR SUITE E
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City | VALPARAISO
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State | IN
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Zip | 46385-7762
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Country | US
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Telephone | 219-548-2322
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Fax | 312-577-0841
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS L CUELLAR
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Credential | D.D.S.
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Telephone | 219-548-2322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12008232A
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License Number State | IN
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