Provider Demographics
NPI:1679783179
Name:ERICK N. CUENCA DMD INC
Entity Type:Organization
Organization Name:ERICK N. CUENCA DMD INC
Other - Org Name:PINOLE 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:714-428-1200
Mailing Address - Street 1:1477 FITZGERALD DR STE 106
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2257
Mailing Address - Country:US
Mailing Address - Phone:510-669-0350
Mailing Address - Fax:
Practice Address - Street 1:1477 FITZGERALD DR STE 106
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2257
Practice Address - Country:US
Practice Address - Phone:510-669-0350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty