Provider Demographics
NPI:1841726130
Name:CUBEROS, MARA FERNANDA (DDS)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:FERNANDA
Last Name:CUBEROS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 TURTLE RUN BLVD APT 1023
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4241
Mailing Address - Country:US
Mailing Address - Phone:954-278-4519
Mailing Address - Fax:
Practice Address - Street 1:1875 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5805
Practice Address - Country:US
Practice Address - Phone:954-320-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN244691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice