Provider Demographics
NPI:1427176049
Name:UCETA, CARMEN ROSA (DDS)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:ROSA
Last Name:UCETA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:CARMEN
Other - Middle Name:ROSA
Other - Last Name:CAPELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4004
Mailing Address - Country:US
Mailing Address - Phone:201-357-2014
Mailing Address - Fax:
Practice Address - Street 1:5917 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1306
Practice Address - Country:US
Practice Address - Phone:201-861-2121
Practice Address - Fax:201-861-9820
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020462001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice