Provider Demographics
NPI:1235349317
Name:ERICK N. CUENCA DMD INC
Entity Type:Organization
Organization Name:ERICK N. CUENCA DMD INC
Other - Org Name:SAN JOSE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:N
Authorized Official - Last Name:CUENCA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-428-1200
Mailing Address - Street 1:2930 ABORN SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1504
Mailing Address - Country:US
Mailing Address - Phone:408-238-1853
Mailing Address - Fax:
Practice Address - Street 1:2930 ABORN SQUARE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1504
Practice Address - Country:US
Practice Address - Phone:408-238-1853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty