Nicole Michelle Quezada, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DS027194L Issued in PA

Practice address

11671 Route 6
Wellsboro, PA 16901-6750

Phone

(570) 724-2565

Fax

(570) 724-3240

NPI assigned

Jun 3, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Thomas G. Lopatofsky, DMD, Nicole M. Quezada, DMD,PC

  • General Practice Dentistry
  • Wellsboro, PA
  • NPI 1538255856
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370217600000",
    "number": "1043657810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11671 ROUTE 6",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169016750",
            "telephone_number": "570-724-2565",
            "fax_number": "570-724-3240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11671 ROUTE 6",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169016750",
            "telephone_number": "570-724-2565",
            "fax_number": "570-724-3240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEZADA",
        "first_name": "NICOLE",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-03",
        "last_updated": "2013-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS027194L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherry D Pierce, DPT
• Kevin L Pigos, M.D.
• George David Pitre, MA,BSL
• Dylan Plume, LAT, ATC
• Maria Polonia, COTAL
• Jeffrey A Ranta, MD
• Gena L. Rasmussen, MS, RD, LDN
• Chelsey Rendos
• Laura J Rice, M.D.
• Richard F. Black, DMD., MPH, PC

• Dentist in Wellsboro, PA
• Providers in Wellsboro, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.