Healthcare Provider Details

I. General information

NPI: 1043811664
Provider Name (Legal Business Name): JOSEPH V. QUEVEDO D.D.S.. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HAGEN DR STE 310
ROCHESTER NY
14625-2664
US

IV. Provider business mailing address

20 HAGEN DR STE 310
ROCHESTER NY
14625-2664
US

V. Phone/Fax

Practice location:
  • Phone: 585-248-2200
  • Fax: 585-248-2208
Mailing address:
  • Phone: 585-248-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ANLIKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 585-248-2200