Provider Demographics
NPI:1225202963
Name:FUENTES, NUBIA E (DDS)
Entity type:Individual
Prefix:DR
First Name:NUBIA
Middle Name:E
Last Name:FUENTES
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 1:205 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4240
Mailing Address - Country:US
Mailing Address - Phone:630-264-8042
Mailing Address - Fax:630-264-8139
Practice Address - Street 1:205 CLARK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4240
Practice Address - Country:US
Practice Address - Phone:630-264-8042
Practice Address - Fax:630-264-8139
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist