Healthcare Provider Details

I. General information

NPI: 1851591184
Provider Name (Legal Business Name): ERIDANIA MARIA BAEZ QUEZADA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 HEMION RD
SUFFERN NY
10901-4919
US

IV. Provider business mailing address

219 SPOOK ROCK RD
SUFFERN NY
10901-3631
US

V. Phone/Fax

Practice location:
  • Phone: 347-661-6638
  • Fax:
Mailing address:
  • Phone: 347-661-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number052104-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: