Provider Demographics
NPI:1124445622
Name:CUELLAR, CARMEN CECILIA (DDS)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:CECILIA
Last Name:CUELLAR
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 1:4000 ALBEMARLE ST NW
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-1851
Mailing Address - Country:US
Mailing Address - Phone:202-363-4361
Mailing Address - Fax:202-363-4362
Practice Address - Street 1:4000 ALBEMARLE ST NW
Practice Address - Street 2:SUITE 203
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-1851
Practice Address - Country:US
Practice Address - Phone:202-363-4361
Practice Address - Fax:202-363-4362
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN48031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice