Provider Demographics
NPI:1053059659
Name:ERICK N CUENCA DMD INC
Entity Type:Organization
Organization Name:ERICK N CUENCA DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:CUENCA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:559-846-6691
Mailing Address - Street 1:45 W WYNDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-7193
Mailing Address - Country:US
Mailing Address - Phone:559-765-6500
Mailing Address - Fax:
Practice Address - Street 1:275 S MADERA AVE STE 200
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1401
Practice Address - Country:US
Practice Address - Phone:559-846-6691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty