Provider Demographics
NPI:1972826170
Name:ILIANA CUELLAR DDS, INC.
Entity Type:Organization
Organization Name:ILIANA CUELLAR DDS, INC.
Other - Org Name:EASY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ILIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-763-2581
Mailing Address - Street 1:1063 NORTH D STREET
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410
Mailing Address - Country:US
Mailing Address - Phone:909-763-2581
Mailing Address - Fax:909-763-2534
Practice Address - Street 1:1063 NORTH D STREET
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410
Practice Address - Country:US
Practice Address - Phone:909-763-2581
Practice Address - Fax:909-763-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty