Andre Sebastian Agama Cueva
Individual provider Active NPI Dentist · Hialeah, FL
NPI 1487413571 · NPPES record last updated May 20, 2024
Key facts
- NPI
- 1487413571
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DRPM2680 (FL)
- Practice address
- 750 E 25TH St
Hialeah, FL 33013-3817 - Phone
- (321) 347-7260
- NPI assigned
- Mar 19, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DRPM2680 | FL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DRPM2680 | FL | Yes |
Addresses
Primary practice location
750 E 25TH St
Hialeah, FL 33013-3817
Mailing address
15090 Book Club Rd
Winter Garden, FL 34787-1766
Phone (321) 347-7260
Other providers in Hialeah, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.