Provider Demographics
NPI:1124404520
Name:DEL CUADRO, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:DEL CUADRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AVE JESUS T PINERO
Mailing Address - Street 2:APT 11K
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4109
Mailing Address - Country:US
Mailing Address - Phone:787-501-1984
Mailing Address - Fax:
Practice Address - Street 1:1090 NORTHCHASE PKWY SE STE 290
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-6402
Practice Address - Country:US
Practice Address - Phone:678-816-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014149961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry