Provider Demographics
NPI:1568671519
Name:ERICK N CUENCA DMD INC
Entity Type:Organization
Organization Name:ERICK N CUENCA DMD INC
Other - Org Name:CLOVIS 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:559-299-9008
Mailing Address - Street 1:1420 SHAW AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4072
Mailing Address - Country:US
Mailing Address - Phone:559-299-9008
Mailing Address - Fax:
Practice Address - Street 1:1420 SHAW AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4072
Practice Address - Country:US
Practice Address - Phone:559-299-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty