Provider Demographics
NPI:1750450052
Name:COSMOPOLITAN DENTISTRY
Entity Type:Organization
Organization Name:COSMOPOLITAN DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-548-2322
Mailing Address - Street 1:225 ABERDEEN DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-7762
Mailing Address - Country:US
Mailing Address - Phone:219-548-2322
Mailing Address - Fax:312-577-0841
Practice Address - Street 1:225 ABERDEEN DR
Practice Address - Street 2:SUITE E
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-7762
Practice Address - Country:US
Practice Address - Phone:219-548-2322
Practice Address - Fax:312-577-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008232A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental