Provider Demographics
NPI:1225248560
Name:JOSE A. ACOSTA-CUEVAS, DDS, INC.
Entity Type:Organization
Organization Name:JOSE A. ACOSTA-CUEVAS, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:ACOSTA-CUEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-683-3775
Mailing Address - Street 1:10232 STATHOS DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5995
Mailing Address - Country:US
Mailing Address - Phone:916-685-4966
Mailing Address - Fax:916-685-5619
Practice Address - Street 1:8461 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-9573
Practice Address - Country:US
Practice Address - Phone:916-683-3775
Practice Address - Fax:916-683-3164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD50555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700917986Other1223G0001X