Provider Demographics
NPI:1407244056
Name:MARIA A CUESTA , DMD, PC
Entity Type:Organization
Organization Name:MARIA A CUESTA , DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUESTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-414-9015
Mailing Address - Street 1:90 WASHINGTON ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1050
Mailing Address - Country:US
Mailing Address - Phone:973-414-9015
Mailing Address - Fax:973-414-9020
Practice Address - Street 1:90 WASHINGTON ST
Practice Address - Street 2:SUITE 209
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1050
Practice Address - Country:US
Practice Address - Phone:973-414-9015
Practice Address - Fax:973-414-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI15274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7577508Medicaid