MEDICARE: DR. ALAN DANIEL QUIRARTE 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	122300000X	Dentist	019.034397	IL

General Provider Information

NPI Number	:	1538844071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN DANIEL QUIRARTE DMD

Provider Business Mailing Address
First Line	:	5321 W WOLFRAM ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5621 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1830
Country	:	US
Telephone Number	:	773-427-1000
Fax Number	:

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

Provider Enumeration Date	:	06/21/2023
Last Update Date	:	06/21/2023

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