Provider Demographics
NPI:1750583696
Name:CEDERQUIST, ROBERT K (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:CEDERQUIST
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 1:609 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1285
Mailing Address - Country:US
Mailing Address - Phone:610-524-7202
Mailing Address - Fax:
Practice Address - Street 1:609 GORDON DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1285
Practice Address - Country:US
Practice Address - Phone:610-524-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026458L1223X0400X
PADS-026458L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics