Provider Demographics
NPI:1790252708
Name:QUEMADO, ELROY DEAN
Entity Type:Individual
Prefix:
First Name:ELROY DEAN
Middle Name:
Last Name:QUEMADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 183RD ST SE APT L205
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7547
Mailing Address - Country:US
Mailing Address - Phone:808-306-6695
Mailing Address - Fax:
Practice Address - Street 1:1019 112TH ST SW
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-4875
Practice Address - Country:US
Practice Address - Phone:425-551-6001
Practice Address - Fax:425-551-6009
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist