Provider Demographics
NPI:1437725983
Name:QUINTANA FERNANDEZ, ADELEYDIS (DMD)
Entity Type:Individual
Prefix:
First Name:ADELEYDIS
Middle Name:
Last Name:QUINTANA FERNANDEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25513 SW 127TH PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-9018
Mailing Address - Country:US
Mailing Address - Phone:786-400-6866
Mailing Address - Fax:
Practice Address - Street 1:5580 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2817
Practice Address - Country:US
Practice Address - Phone:941-914-9181
Practice Address - Fax:941-914-9161
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL258841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty