MEDICARE: WANDA FEBO-CUELLO, D.M.D, P.C.

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	122300000X	Dentist	DN 14436	FL

General Provider Information

NPI Number	:	1790863330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WANDA FEBO-CUELLO, D.M.D, P.C.

Provider Business Mailing Address
First Line	:	1620 S. CONGRESS AVENUE
Second Line	:	SUITE 102
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-2128
Country	:	US
Telephone Number	:	561-434-6661
Fax Number	:	561-434-6662

Provider Business Practice Location Address
First Line	:	1620 S CONGRESS AVE
Second Line	:	SUITE 102
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-2128
Country	:	US
Telephone Number	:	561-434-6661
Fax Number	:	561-434-6662

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WANDA FEBO-CUELLO
Credential	:	D.M.D.
Telephone Number	:	561-434-6661

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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