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General NPI Number Information
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NPI Number | 1902140833
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Entity Type | Organization
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Legal Business Name | CUARTAS ADVANCED DENTISTRY
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 10650 W STATE ROAD 84 STE 213
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City | DAVIE
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State | FL
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Zip | 33324-4235
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Country | US
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Telephone | 954-424-3220
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Fax | 954-424-3223
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Provider Business Mailing Address
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Address Line | 10650 W STATE ROAD 84 STE 213
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City | DAVIE
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State | FL
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Zip | 33324-4235
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Country | US
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Telephone | 954-424-3220
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Fax | 954-424-3223
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDRA PATRICIA CUARTAS
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Credential | D.D.S.
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Telephone | 954-424-3220
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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 | DN 18113
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License Number State | FL
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