Provider Demographics
NPI:1871629220
Name:QUESADA, ROBERT E (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:QUESADA
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 1:1500 E BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2189
Mailing Address - Country:US
Mailing Address - Phone:954-463-1077
Mailing Address - Fax:954-463-0905
Practice Address - Street 1:1500 E BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2189
Practice Address - Country:US
Practice Address - Phone:954-463-1077
Practice Address - Fax:954-463-0905
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 141401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice