Provider Demographics
NPI:1063621605
Name:DEL CUETO, GRISEL (DDS)
Entity type:Individual
Prefix:DR
First Name:GRISEL
Middle Name:
Last Name:DEL CUETO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9954 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-3010
Mailing Address - Country:US
Mailing Address - Phone:818-893-5898
Mailing Address - Fax:
Practice Address - Street 1:18440 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4218
Practice Address - Country:US
Practice Address - Phone:818-774-9709
Practice Address - Fax:818-827-3086
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice