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NPI Code Detail

MEDICARE: COLLEEN QUESADA DMD PLLC

MEDICARE: COLLEEN QUESADA DMD PLLC
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
1122300000XDentist18173MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D801268OTHERMIBCBS OF MI PIN

General Provider Information

NPI Number : 1982861829
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLLEEN QUESADA DMD PLLC
Provider Business Mailing Address
First Line : 301 W MAIN ST
Second Line : PO BOX 309
City : FARWELL
State : MI
Zip : 48622-8753
Country : US
Telephone Number : 989-588-4121
Fax Number : 989-588-3191
Provider Business Practice Location Address
First Line : 301 W MAIN ST
Second Line :
City : FARWELL
State : MI
Zip : 48622-8753
Country : US
Telephone Number : 989-588-4121
Fax Number : 989-588-3191
Authorized Official
Title or Position : OWNER
Name : DR. COLLEEN S QUESADA
Credential : D.M.D
Telephone Number : 989-588-4121
Provider Enumeration Date : 05/19/2008
Last Update Date : 05/19/2008

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Directions to “COLLEEN QUESADA DMD PLLC ” Practice Location

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