1245482702 NPI number — DR. CARLOS GUSTAVO CUELLAR DENTIST

Table of content: DR. CARLOS GUSTAVO CUELLAR DENTIST (NPI 1245482702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245482702 NPI number — DR. CARLOS GUSTAVO CUELLAR DENTIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUELLAR
Provider First Name:
CARLOS
Provider Middle Name:
GUSTAVO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DENTIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245482702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4530 RODEO LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAREDO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78046-7522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-753-7752
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3307 FRANCISCO MINA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NUEVO LAREDO
Provider Business Practice Location Address State Name:
TAMAULIPAS
Provider Business Practice Location Address Postal Code:
88000
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
867-187-0663
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5163772 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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