MEDICARE: FERNANDO F QUEVEDO JR. D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN 21354	FL

General Provider Information

NPI Number	:	1699157800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO F QUEVEDO JR. D.D.S

Provider Business Mailing Address
First Line	:	10320 SW 49TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-6220
Country	:	US
Telephone Number	:	786-554-2247
Fax Number	:

Provider Business Practice Location Address
First Line	:	10320 SW 49TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-6220
Country	:	US
Telephone Number	:	786-554-2247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2015
Last Update Date	:	06/24/2015

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Directions to “ FERNANDO F QUEVEDO JR. D.D.S” Practice Location

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