MEDICARE: MS. ANA MARIA QUESADA GORDILLO

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	30293	FL

General Provider Information

NPI Number	:	1932949104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANA MARIA QUESADA GORDILLO

Provider Business Mailing Address
First Line	:	3057 ROUTE 50
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2956
Country	:	US
Telephone Number	:	518-581-2626
Fax Number	:

Provider Business Practice Location Address
First Line	:	3057 ROUTE 50
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2956
Country	:	US
Telephone Number	:	518-581-2626
Fax Number	:

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

Provider Enumeration Date	:	05/27/2024
Last Update Date	:	01/21/2026

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