Provider Demographics
NPI:1942683065
Name:QUEVEDO, RACHEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:QUEVEDO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 SW 49TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6220
Mailing Address - Country:US
Mailing Address - Phone:786-554-3708
Mailing Address - Fax:
Practice Address - Street 1:10051 PINES BLVD
Practice Address - Street 2:UNIT C-D
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6186
Practice Address - Country:US
Practice Address - Phone:954-941-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN214201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice