Provider Demographics
NPI:1710739859
Name:SOTOMAYOR CUESTA, THAYLON (DMD)
Entity type:Individual
Prefix:DR
First Name:THAYLON
Middle Name:
Last Name:SOTOMAYOR CUESTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 WESTFIELD AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1622
Mailing Address - Country:US
Mailing Address - Phone:908-353-0900
Mailing Address - Fax:
Practice Address - Street 1:1761 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4111
Practice Address - Country:US
Practice Address - Phone:954-990-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN289621223G0001X
NJ22DI030314001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice