Healthcare Provider Details

I. General information

NPI: 1881458941
Provider Name (Legal Business Name): PIERRE MIKE QUERETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 OXON HILL RD
OXON HILL MD
20745-1117
US

IV. Provider business mailing address

2009 8TH ST NW APT 502
WASHINGTON DC
20001-5755
US

V. Phone/Fax

Practice location:
  • Phone: 301-686-0710
  • Fax:
Mailing address:
  • Phone: 305-922-0742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18642
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: