Active NPI
Max J Quezada, D.D.S.
- Dentist
- San Bernardino, CA
National Provider Identifier
1265601256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 25441
- Practice address
- 3972 N Waterman Ave
San Bernardino, CA 92404-1700 - Phone
- (951) 264-1733
- NPI assigned
- Feb 25, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 25441 | CA | Primary |
Addresses
Primary practice location
3972 N Waterman Ave
San Bernardino, CA 92404-1700
Mailing address
3972 N Waterman Ave Ste 103
San Bernardino, CA 92404-1767
Phone (909) 726-1578
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 25441 | Other | CA | CA DENTAL LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671580800000",
"number": "1265601256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3972 N WATERMAN AVE STE 103",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924041767",
"telephone_number": "909-726-1578",
"fax_number": "909-726-1577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3972 N WATERMAN AVE",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924041700",
"telephone_number": "951-264-1733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUEZADA",
"first_name": "MAX",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-25",
"last_updated": "2022-12-21",
"certification_date": "2022-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "25441",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA DENTAL LICENSE #",
"identifier": "25441",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.