MEDICARE: VALENTIN CUARTO III D.D.S

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	5220	WI

General Provider Information

NPI Number	:	1346395118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALENTIN CUARTO III D.D.S

Provider Business Mailing Address
First Line	:	1519 S CANDLESTICK WAY
Second Line	:
City	:	WAUKEGAN
State	:	IL
Zip	:	60085-8648
Country	:	US
Telephone Number	:	847-360-0599
Fax Number	:

Provider Business Practice Location Address
First Line	:	27620 75TH ST
Second Line	:	SUITE 3
City	:	SALEM
State	:	WI
Zip	:	53168-9530
Country	:	US
Telephone Number	:	262-843-1808
Fax Number	:	262-843-1908

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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