Individual
CORINA ADELAIDA CUSTELCEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8376 OLD TROY PIKE, HUBER HEIGHTS, OH 45424-1028
(937) 938-7678
Mailing address
8376 OLD TROY PIKE, HUBER HEIGHTS, OH 45424-1028
(937) 938-7678
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30-022087
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2603392
—
OH
01
—
9181221
DORAL
OH
Enumeration date
04/03/2006
Last updated
05/29/2014
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