Healthcare Provider Details

I. General information

NPI: 1417269432
Provider Name (Legal Business Name): PATRICK RYAN QUINN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 W MICHIGAN ST
INDIANAPOLIS IN
46202-5186
US

IV. Provider business mailing address

PO BOX 11949
FORT WAYNE IN
46862-1949
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-7433
  • Fax:
Mailing address:
  • Phone: 260-458-2641
  • Fax: 260-458-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12011475A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: