Healthcare Provider Details

I. General information

NPI: 1740456425
Provider Name (Legal Business Name): QUEST DENTAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 JUAN ESCUTIA NTE
CD. JUAREZ CHIHUAHUA
32300
MX

IV. Provider business mailing address

1821 N ZARAGOZA RD # 642
EL PASO TX
79936-7912
US

V. Phone/Fax

Practice location:
  • Phone: 526566163402
  • Fax:
Mailing address:
  • Phone: 915-241-5622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: LAURA E HAYS
Title or Position: ADMINISTRATOR
Credential:
Phone: 915-241-5622