Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 1367 | PR |
NPI | 1003886607 |
---|---|
Provider Name | Jose Quesada |
First Address | Pensacola, FL 32512-0001 |
Second Address | Pensacola, FL 32512-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 01/08/2007 |