Provider Demographics
NPI:1902140833
Name:CUARTAS ADVANCED DENTISTRY
Entity Type:Organization
Organization Name:CUARTAS ADVANCED DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:CUARTAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-424-3220
Mailing Address - Street 1:10650 W STATE ROAD 84 STE 213
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4235
Mailing Address - Country:US
Mailing Address - Phone:954-424-3220
Mailing Address - Fax:954-424-3223
Practice Address - Street 1:10650 W STATE ROAD 84 STE 213
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4235
Practice Address - Country:US
Practice Address - Phone:954-424-3220
Practice Address - Fax:954-424-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 18113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty