Provider Demographics
NPI:1447816673
Name:QUITO CALDERON, PRISCILA CUMANDA (DMD)
Entity type:Individual
Prefix:DR
First Name:PRISCILA
Middle Name:CUMANDA
Last Name:QUITO CALDERON
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 1:1464 SOPHIE WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3984
Mailing Address - Country:US
Mailing Address - Phone:407-459-3276
Mailing Address - Fax:
Practice Address - Street 1:1464 SOPHIE WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3984
Practice Address - Country:US
Practice Address - Phone:407-459-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN254001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice