Healthcare Provider Details

I. General information

NPI: 1942351549
Provider Name (Legal Business Name): RHETT MARVIN QUIST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 TUTT BLVD SUITE 250
COLORADO SPRINGS CO
80923-3500
US

IV. Provider business mailing address

6160 TUTT BLVD SUITE 250
COLORADO SPRINGS CO
80923-3500
US

V. Phone/Fax

Practice location:
  • Phone: 719-359-8652
  • Fax: 719-623-5771
Mailing address:
  • Phone: 719-359-8652
  • Fax: 719-623-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8040
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: