Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 30-023726 | OH |
NPI | 1003244005 |
---|---|
Provider Name | Dr. Chelsey Katherine Cueto |
First Address | Massillon, OH 44646-1207 |
Second Address | North Canton, OH 44720-8412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2013 |
Last Update Date | 29/10/2013 |