Healthcare Provider Details

I. General information

NPI: 1265559330
Provider Name (Legal Business Name): HUGO QUINONES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 NEW BRUNSWICK AVE SUITE 101
PERTH AMBOY NJ
08861-3675
US

IV. Provider business mailing address

133 SEVERIN COURT
CRANFORD NJ
07016
US

V. Phone/Fax

Practice location:
  • Phone: 732-442-0117
  • Fax:
Mailing address:
  • Phone: 732-442-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI01957800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: