MEDICARE: DR. JOHN MICHAEL QUINN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6115	NV

General Provider Information

NPI Number	:	1285936245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL QUINN DMD

Provider Business Mailing Address
First Line	:	3220 S DURANGO DR STE B2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4410
Country	:	US
Telephone Number	:	702-795-2273
Fax Number	:	702-795-7222

Provider Business Practice Location Address
First Line	:	3220 S DURANGO DR STE B2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4410
Country	:	US
Telephone Number	:	702-795-2273
Fax Number	:	702-795-7222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	09/26/2011

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