Provider Demographics
NPI:1992105688
Name:DE QUESADA, DIANA (DMD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:DE QUESADA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17800 ATLANTIC BLVD.
Mailing Address - Street 2:APT. 405
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2706
Mailing Address - Country:US
Mailing Address - Phone:786-587-2494
Mailing Address - Fax:
Practice Address - Street 1:17800 ATLANTIC BLVD.
Practice Address - Street 2:APT. 405
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2706
Practice Address - Country:US
Practice Address - Phone:786-587-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist