Provider Demographics
NPI:1821387309
Name:QUEZADA, ERNESTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
Last Name:QUEZADA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8821 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1411
Mailing Address - Country:US
Mailing Address - Phone:305-279-0202
Mailing Address - Fax:305-667-0368
Practice Address - Street 1:8821 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1411
Practice Address - Country:US
Practice Address - Phone:305-279-0202
Practice Address - Fax:305-595-0060
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist