Healthcare Provider Details

I. General information

NPI: 1659050425
Provider Name (Legal Business Name): DUY BAO QUAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDDAC-BAVARIA CMR 411 APO/AE 09112
ANSBACH BAVARIA
09112
DE

IV. Provider business mailing address

MEDDAC-BAVARIA CMR 411 APO/AE 09112
ANSBACH BAVARIA
09112
DE

V. Phone/Fax

Practice location:
  • Phone: 637-194-6436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS044151
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: