Provider Demographics
NPI:1245451384
Name:QUEVEDO, JOSEPH VINCENT (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VINCENT
Last Name:QUEVEDO
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HAGEN DR STE 310
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2664
Mailing Address - Country:US
Mailing Address - Phone:585-248-2200
Mailing Address - Fax:585-248-2208
Practice Address - Street 1:20 HAGEN DR STE 310
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2664
Practice Address - Country:US
Practice Address - Phone:585-248-2200
Practice Address - Fax:585-248-2208
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047178-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics