MEDICARE: CECILIA CUELLAR DDS PC

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	4803	DC

General Provider Information

NPI Number	:	1821185034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CECILIA CUELLAR DDS PC

Provider Business Mailing Address
First Line	:	4000 ALBEMARLE ST NW STE 203
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-1851
Country	:	US
Telephone Number	:	202-363-4361
Fax Number	:	202-363-4362

Provider Business Practice Location Address
First Line	:	4000 ALBEMARLE ST NW STE 203
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-1851
Country	:	US
Telephone Number	:	202-363-4361
Fax Number	:	202-363-4362

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. CECILIA CUELLAR
Credential	:	DDS
Telephone Number	:	202-363-4361

Provider Enumeration Date	:	10/07/2006
Last Update Date	:	08/22/2020

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