Provider Demographics
NPI:1477100022
Name:L CUESTAS DENTAL CORPORATION
Entity Type:Organization
Organization Name:L CUESTAS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:CUESTAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-851-0643
Mailing Address - Street 1:44853 PORTOLA AVE
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3703
Mailing Address - Country:US
Mailing Address - Phone:760-851-0643
Mailing Address - Fax:
Practice Address - Street 1:44853 PORTOLA AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3703
Practice Address - Country:US
Practice Address - Phone:760-851-0643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty