MEDICARE: DR. GERARDO DAVID QUINONES 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	6346	OK
2	1223G0001X	General Practice Dentistry	1436	PR
3	1223G0001X	General Practice Dentistry	28762	TX
4	1223G0001X	General Practice Dentistry	D7196	AZ

General Provider Information

NPI Number	:	1871597302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARDO DAVID QUINONES DMD

Provider Business Mailing Address
First Line	:	136 KESSLER LN
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-8409
Country	:	US
Telephone Number	:	520-425-5058
Fax Number	:	361-358-9787

Provider Business Practice Location Address
First Line	:	1703 N SAINT MARYS ST
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-2738
Country	:	US
Telephone Number	:	361-358-9780
Fax Number	:	361-358-9787

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	05/14/2021

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