Provider Demographics
NPI:1407804255
Name:CUADROS, RACHEL SUSANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:SUSANNE
Last Name:CUADROS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19160 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8135
Mailing Address - Country:US
Mailing Address - Phone:708-577-5015
Mailing Address - Fax:708-479-7747
Practice Address - Street 1:19160 88TH AVE
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8135
Practice Address - Country:US
Practice Address - Phone:708-577-5015
Practice Address - Fax:708-479-7747
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0250101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice