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General NPI Number Information
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NPI Number | 1932764107
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Entity Type | Organization
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Legal Business Name | CUADRA PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 05/03/2019
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | CUADRA PEDIATRIC DENTISTRY, LLC 486 WENTZ STREET
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City | TIFFIN
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State | OH
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Zip | 44883
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Country | US
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Telephone | 513-685-0114
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Fax |
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Provider Business Mailing Address
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Address Line | CUADRA PEDIATRIC DENTISTRY, LLC 486 WENTZ STREET
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City | TIFFIN
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State | OH
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Zip | 44883
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Country | US
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Telephone | 513-685-0114
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Fax |
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Authorized Official
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Title or Position | OWNER, DENTIST
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Name | DANIELA CUADRA
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Credential | DDS
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Telephone | 513-685-0114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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