Healthcare Provider Details

I. General information

NPI: 1356470496
Provider Name (Legal Business Name): KATHERINE QUIST DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 THE ALAMEDA
BERKELEY CA
94709-1907
US

IV. Provider business mailing address

1206 THE ALAMEDA
BERKELEY CA
94709-1907
US

V. Phone/Fax

Practice location:
  • Phone: 510-525-7521
  • Fax: 510-525-5262
Mailing address:
  • Phone: 510-525-7521
  • Fax: 510-525-5262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number35648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: