Provider Demographics
NPI:1588217178
Name:CUEVAS RUIZ, IVAN LEANDROS
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:LEANDROS
Last Name:CUEVAS RUIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 GREENWALD WAY N
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0768
Mailing Address - Country:US
Mailing Address - Phone:786-715-7999
Mailing Address - Fax:
Practice Address - Street 1:3304 GREENWALD WAY N
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0768
Practice Address - Country:US
Practice Address - Phone:407-520-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist