Provider Demographics
NPI:1437294543
Name:ACUESTA-LAURETA, ELA
Entity Type:Individual
Prefix:DR
First Name:ELA
Middle Name:
Last Name:ACUESTA-LAURETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 58TH RD
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2806
Mailing Address - Country:US
Mailing Address - Phone:718-792-0137
Mailing Address - Fax:718-792-0401
Practice Address - Street 1:7 HUGH GRANT CIRCLE SUITE 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462
Practice Address - Country:US
Practice Address - Phone:718-792-5959
Practice Address - Fax:718-792-0401
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0529141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice