Healthcare Provider Details

I. General information

NPI: 1932949104
Provider Name (Legal Business Name): MS. ANA MARIA QUESADA GORDILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410A BALLTOWN RD
SCHENECTADY NY
12304-2245
US

IV. Provider business mailing address

410A BALLTOWN RD
SCHENECTADY NY
12304-2245
US

V. Phone/Fax

Practice location:
  • Phone: 518-387-3145
  • Fax:
Mailing address:
  • Phone: 518-387-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: