Provider Demographics
NPI:1588449896
Name:CUELLAR SMILE, INC
Entity type:Organization
Organization Name:CUELLAR SMILE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CUELLAR GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-856-2506
Mailing Address - Street 1:1340 TUSKAWILLA RD STE 108
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5030
Mailing Address - Country:US
Mailing Address - Phone:407-695-2005
Mailing Address - Fax:407-695-8384
Practice Address - Street 1:1340 TUSKAWILLA RD STE 108
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5030
Practice Address - Country:US
Practice Address - Phone:407-695-2005
Practice Address - Fax:407-595-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental