MEDICARE: DR. DENNIS LEROY QUINLAN DDS

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	D7698	MN

General Provider Information

NPI Number	:	1932285764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS LEROY QUINLAN DDS

Provider Business Mailing Address
First Line	:	PO BOX 371
Second Line	:	57 BIRCH AVE S
City	:	MAPLE LAKE
State	:	MN
Zip	:	55358-0371
Country	:	US
Telephone Number	:	320-963-3794
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 BIRCH AVE S
Second Line	:
City	:	MAPLE LAKE
State	:	MN
Zip	:	55358-0371
Country	:	US
Telephone Number	:	320-963-3794
Fax Number	:

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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