Provider Demographics
NPI:1821092172
Name:QUEVEDO, DANIEL TRAVIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:TRAVIS
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 1:505 WEKIVA SPRINGS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-6050
Mailing Address - Country:US
Mailing Address - Phone:407-786-2552
Mailing Address - Fax:
Practice Address - Street 1:505 WEKIVA SPRINGS RD
Practice Address - Street 2:STE 100
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-6050
Practice Address - Country:US
Practice Address - Phone:407-786-2552
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 147751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN 14775OtherSTATE LICENSE