Provider Demographics
NPI:1710149026
Name:CUADROS, SERGIO (DDS)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:
Last Name:CUADROS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-4409
Mailing Address - Country:US
Mailing Address - Phone:269-927-1313
Mailing Address - Fax:269-934-9447
Practice Address - Street 1:16100 KING RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7972
Practice Address - Country:US
Practice Address - Phone:734-479-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010160531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice