Provider Demographics
NPI:1235222134
Name:FEBO-CUELLO, WANDA (DMD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:FEBO-CUELLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 S CONGRESS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2128
Mailing Address - Country:US
Mailing Address - Phone:561-434-6661
Mailing Address - Fax:561-434-6662
Practice Address - Street 1:1620 S CONGRESS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2128
Practice Address - Country:US
Practice Address - Phone:561-434-6661
Practice Address - Fax:561-434-6662
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 144361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice