Provider Demographics
NPI:1104160639
Name:CUELLAR, RUBEN DARIO (DDS)
Entity type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:DARIO
Last Name:CUELLAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 COLUMBIA PIKE STE 102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-3117
Mailing Address - Country:US
Mailing Address - Phone:703-505-1285
Mailing Address - Fax:703-575-9890
Practice Address - Street 1:5555 COLUMBIA PIKE STE 102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-3117
Practice Address - Country:US
Practice Address - Phone:703-575-9899
Practice Address - Fax:703-575-9890
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist