Provider Demographics
NPI:1932764107
Name:CUADRA PEDIATRIC DENTISTRY, LLC
Entity type:Organization
Organization Name:CUADRA PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUADRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-685-0114
Mailing Address - Street 1:CUADRA PEDIATRIC DENTISTRY, LLC
Mailing Address - Street 2:486 WENTZ STREET
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883
Mailing Address - Country:US
Mailing Address - Phone:513-685-0114
Mailing Address - Fax:
Practice Address - Street 1:CUADRA PEDIATRIC DENTISTRY, LLC
Practice Address - Street 2:486 WENTZ STREET
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883
Practice Address - Country:US
Practice Address - Phone:513-685-0114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty