Healthcare Provider Details

I. General information

NPI: 1689426892
Provider Name (Legal Business Name): GUSTAVO TERRERO QUEVEDO D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10783 NW 41ST ST
DORAL FL
33178-1867
US

IV. Provider business mailing address

10783 NW 41ST ST
DORAL FL
33178-1867
US

V. Phone/Fax

Practice location:
  • Phone: 305-539-9090
  • Fax:
Mailing address:
  • Phone: 305-539-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32157
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: