Provider Demographics
NPI:1053586883
Name:CUELLAR, LUIS L JR (DDS)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:L
Last Name:CUELLAR
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 ABERDEEN DRIVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385
Mailing Address - Country:US
Mailing Address - Phone:219-548-2322
Mailing Address - Fax:312-577-0841
Practice Address - Street 1:225 ABERDEEN DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385
Practice Address - Country:US
Practice Address - Phone:219-548-2322
Practice Address - Fax:312-577-0841
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008232A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice