Provider Demographics
NPI:1518767193
Name:QUISPE, KEYDY LADY (RDH)
Entity type:Individual
Prefix:
First Name:KEYDY
Middle Name:LADY
Last Name:QUISPE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 NEW HAVEN AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-1918
Mailing Address - Country:US
Mailing Address - Phone:908-461-8411
Mailing Address - Fax:
Practice Address - Street 1:1661 NEW HAVEN AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-1918
Practice Address - Country:US
Practice Address - Phone:908-461-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22HI01291700124Q00000X
PADH075833124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist