Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 136000206 | IL |
N | 122300000X | Dentist | DL12079 | MA |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 019-031959 | IL |
N | 204E00000X | Oral & Maxillofacial Surgeon | 019-031959 | IL |
NPI | 1487081519 |
---|---|
Provider Name | Maria Carolina Cuevas-Nunez |
First Address | Downers Grove, IL 60515-1235 |
Second Address | Downers Grove, IL 60515-5430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2013 |
Last Update Date | 22/04/2021 |