MEDICARE: DR. MARTIN CARLOS CUELLAR DDS

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	9300	TX

General Provider Information

NPI Number	:	1386654358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN CARLOS CUELLAR DDS

Provider Business Mailing Address
First Line	:	13231 CHAMPION FOREST DR
Second Line	:	SUITE 304
City	:	HOUSTON
State	:	TX
Zip	:	77069-2600
Country	:	US
Telephone Number	:	281-444-2755
Fax Number	:

Provider Business Practice Location Address
First Line	:	13231 CHAMPION FOREST DR
Second Line	:	SUITE 304
City	:	HOUSTON
State	:	TX
Zip	:	77069-2600
Country	:	US
Telephone Number	:	281-444-2755
Fax Number	:

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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