Healthcare Provider Details

I. General information

NPI: 1851599781
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: 07/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 CLOVER ST
ROCHESTER NY
14618-4517
US

IV. Provider business mailing address

2425 CLOVER ST
ROCHESTER NY
14618-4517
US

V. Phone/Fax

Practice location:
  • Phone: 585-256-2200
  • Fax: 585-256-0443
Mailing address:
  • Phone: 585-256-2200
  • Fax: 585-256-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number047178-1
License Number StateNY

VIII. Authorized Official

Name: DR. JOSEPH VINCENT QUEVEDO
Title or Position: OWNER
Credential: D.D.S., P.C.
Phone: 585-256-2200