Provider Demographics
NPI:1225047764
Name:QUEZADA, GUADALUPE (DDS)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W HERMOSA ST
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-1913
Mailing Address - Country:US
Mailing Address - Phone:559-562-8002
Mailing Address - Fax:559-562-4562
Practice Address - Street 1:419 W HERMOSA ST
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-1913
Practice Address - Country:US
Practice Address - Phone:559-562-8002
Practice Address - Fax:559-562-4562
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA453121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4531201OtherMEDICAL BILLING NUMBER