Provider Demographics
NPI:1538130869
Name:QUESADA, LILIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LILIAN
Middle Name:
Last Name:QUESADA
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 1:21 GRAND STREET
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-550-7500
Mailing Address - Fax:860-550-7501
Practice Address - Street 1:21 GRAND STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-550-7500
Practice Address - Fax:860-550-7501
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0088321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT30451OtherCONTROLLED SUBSTANCE
CT004235992Medicaid
CT008832OtherDENTIST LICENSE