Healthcare Provider Details

I. General information

NPI: 1215913587
Provider Name (Legal Business Name): PAUL J QUIRAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 W BROADWAY
PLAINVIEW MN
55964-1256
US

IV. Provider business mailing address

PO BOX 518 338 WEST BROADWAY
PLAINVIEW MN
55964-0518
US

V. Phone/Fax

Practice location:
  • Phone: 507-534-3127
  • Fax: 507-534-2990
Mailing address:
  • Phone: 507-534-3127
  • Fax: 507-534-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberMND10446
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: