Healthcare Provider Details

I. General information

NPI: 1710143110
Provider Name (Legal Business Name): QUIRAM DENTAL, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 W BROADWAY
PLAINVIEW MN
55964-1256
US

IV. Provider business mailing address

338 W BROADWAY PO BOX 518
PLAINVIEW MN
55964-1256
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: DR. PAUL JAMES QUIRAM
Title or Position: DENTIST
Credential: DDS
Phone: 507-534-3127