Provider Demographics
NPI:1851470405
Name:DR. WANDA FEBO-CUELLO, P.C.
Entity Type:Organization
Organization Name:DR. WANDA FEBO-CUELLO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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:617-569-3131
Mailing Address - Street 1:38 CENTRAL SQUARE
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128
Mailing Address - Country:US
Mailing Address - Phone:617-569-3131
Mailing Address - Fax:617-567-5361
Practice Address - Street 1:38 CENTRAL SQ
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1911
Practice Address - Country:US
Practice Address - Phone:617-569-3131
Practice Address - Fax:617-567-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty