Provider Demographics
NPI:1447064183
Name:PENA CUEVAS, HECTOR RAFAEL
Entity type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:RAFAEL
Last Name:PENA CUEVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17640 S TAMIAMI TRL STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4840
Mailing Address - Country:US
Mailing Address - Phone:239-267-1900
Mailing Address - Fax:
Practice Address - Street 1:17640 S TAMIAMI TRL STE 300
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4840
Practice Address - Country:US
Practice Address - Phone:239-267-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN31009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist