Provider Demographics
NPI:1619176252
Name:CUA, GRACIA (DMD)
Entity Type:Individual
Prefix:
First Name:GRACIA
Middle Name:
Last Name:CUA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 JUNIPERO SERRA BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-1987
Mailing Address - Country:US
Mailing Address - Phone:650-991-2288
Mailing Address - Fax:
Practice Address - Street 1:2171 JUNIPERO SERRA BLVD, SUITE 110
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014
Practice Address - Country:US
Practice Address - Phone:650-991-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics