Provider Demographics
NPI:1053300780
Name:CUESTAS, LUZ M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:M
Last Name:CUESTAS
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 1:44853 PORTOLA AVE
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3703
Mailing Address - Country:US
Mailing Address - Phone:760-851-0643
Mailing Address - Fax:516-538-3331
Practice Address - Street 1:44853 PORTOLA AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:760-851-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-15
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0505931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02427172Medicaid