Active NPI
Jorge Del Cuadro
- Pediatric Dentistry
- Marietta, GA
National Provider Identifier
1124404520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 0401414996
- Practice address
- 1090 Northchase Pkwy SE Ste 290
Marietta, GA 30067-6402 - Phone
- (678) 816-4917
- NPI assigned
- Aug 7, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 0401414996 | VA | Primary |
Addresses
Primary practice location
1090 Northchase Pkwy SE Ste 290
Marietta, GA 30067-6402
Mailing address
200 Ave Jesus T Pinero
Apt 11K
San Juan, PR 00918-4109
Phone (787) 501-1984
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401414996 | VA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438905600000",
"number": "1124404520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 AVE JESUS T PINERO",
"address_2": "APT 11K",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009184109",
"telephone_number": "787-501-1984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1090 NORTHCHASE PKWY SE STE 290",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300676402",
"telephone_number": "678-816-4917"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEL CUADRO",
"first_name": "JORGE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-07",
"last_updated": "2015-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "VA",
"license": "0401414996",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.