Provider Demographics
NPI:1790863330
Name:WANDA FEBO-CUELLO, D.M.D, P.C.
Entity Type:Organization
Organization Name:WANDA FEBO-CUELLO, D.M.D, P.C.
Other - Org Name:DENTAL OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEBO-CUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-434-6661
Mailing Address - Street 1:1620 S. CONGRESS AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2128
Mailing Address - Country:US
Mailing Address - Phone:561-434-6661
Mailing Address - Fax:561-434-6662
Practice Address - Street 1:1620 S CONGRESS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2128
Practice Address - Country:US
Practice Address - Phone:561-434-6661
Practice Address - Fax:561-434-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 14436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty