Healthcare Provider Details

I. General information

NPI: 1619084985
Provider Name (Legal Business Name): JOSEPH MCQUIRTER SR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 S. WILMINGTON AVE
LOS ANGELES CA
90059
US

IV. Provider business mailing address

12021 S. WILMINGTON AVE
LOS ANGELES CA
90059
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-5363
  • Fax: 562-427-8802
Mailing address:
  • Phone: 562-427-5363
  • Fax: 562-427-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number25743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: