Provider Demographics
NPI:1265601256
Name:QUEZADA, MAX J (DDS)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:J
Last Name:QUEZADA
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 1:3972 N WATERMAN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-1767
Mailing Address - Country:US
Mailing Address - Phone:909-726-1578
Mailing Address - Fax:909-726-1577
Practice Address - Street 1:3972 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-1700
Practice Address - Country:US
Practice Address - Phone:951-264-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25441OtherCA DENTAL LICENSE #