MEDICARE: CUEVAS DENTAL INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1235806480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUEVAS DENTAL INC.

Provider Business Mailing Address
First Line	:	6542 EL SELINDA AVE
Second Line	:
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-3108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6542 EL SELINDA AVE
Second Line	:
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-3108
Country	:	US
Telephone Number	:	562-374-3305
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ERIKA CUEVAS
Credential	:	DDS
Telephone Number	:	562-374-3305

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	08/25/2021

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