Healthcare Provider Details

I. General information

NPI: 1134035116
Provider Name (Legal Business Name): QUINTERO DENTAL TEMPLE TERRACE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 E 131ST AVE UNIT 104
TEMPLE TERRACE FL
33617-1244
US

IV. Provider business mailing address

5340 E 131ST AVE UNIT 104
TEMPLE TERRACE FL
33617-1244
US

V. Phone/Fax

Practice location:
  • Phone: 813-297-9887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. YALISSY QUINTERO MARTINEZ
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 813-297-9887