Healthcare Provider Details

I. General information

NPI: 1194911974
Provider Name (Legal Business Name): CHARLES L QUINLAN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 N. FRESNO STREET #203
FRESNO CA
93720
US

IV. Provider business mailing address

7055 N. FRESNO STREET #203
FRESNO CA
93720
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-9983
  • Fax: 559-448-9986
Mailing address:
  • Phone: 559-448-9983
  • Fax: 559-448-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number15763
License Number StateCA

VIII. Authorized Official

Name: DR. CHARLES L QUINLAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 559-448-9983