MEDICARE: DR. DANIEL TRAVIS QUEVEDO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN 14775	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN 14775	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1821092172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL TRAVIS QUEVEDO DDS

Provider Business Mailing Address
First Line	:	505 WEKIVA SPRINGS RD
Second Line	:	STE 100
City	:	LONGWOOD
State	:	FL
Zip	:	32779-6050
Country	:	US
Telephone Number	:	407-786-2552
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 WEKIVA SPRINGS RD
Second Line	:	STE 100
City	:	LONGWOOD
State	:	FL
Zip	:	32779-6050
Country	:	US
Telephone Number	:	407-786-2552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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