Provider Demographics
NPI:1386079887
Name:QUERIDO, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:QUERIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3754
Mailing Address - Country:US
Mailing Address - Phone:410-528-0300
Mailing Address - Fax:410-528-1204
Practice Address - Street 1:2 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3754
Practice Address - Country:US
Practice Address - Phone:410-528-0300
Practice Address - Fax:410-528-1204
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist