Provider Demographics
NPI:1073825352
Name:QUEVEDO, CRISTOBAL ALBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRISTOBAL
Middle Name:ALBERTO
Last Name:QUEVEDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 HARRISON AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2362
Mailing Address - Country:US
Mailing Address - Phone:857-413-0631
Mailing Address - Fax:
Practice Address - Street 1:761 HARRISON AVE APT 205
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2362
Practice Address - Country:US
Practice Address - Phone:857-413-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL109971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery