Provider Demographics
NPI:1912112194
Name:TMJ DISORDERS OROFACIAL PAIN CENTER
Entity Type:Organization
Organization Name:TMJ DISORDERS OROFACIAL PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUEVA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-298-9186
Mailing Address - Street 1:850 N KOLB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1333
Mailing Address - Country:US
Mailing Address - Phone:520-298-9186
Mailing Address - Fax:520-298-9608
Practice Address - Street 1:850 N KOLB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1333
Practice Address - Country:US
Practice Address - Phone:520-298-9186
Practice Address - Fax:520-298-9608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4543204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75899Medicare ID - Type Unspecified