Healthcare Provider Details

I. General information

NPI: 1609178177
Provider Name (Legal Business Name): QUINTIN DAVID RUPP DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 WYOMING BLVD NE STE C
ALBUQUERQUE NM
87112-2679
US

IV. Provider business mailing address

8604 QUAIL CREEK CT NE
ALBUQUERQUE NM
87113-1728
US

V. Phone/Fax

Practice location:
  • Phone: 505-458-0132
  • Fax:
Mailing address:
  • Phone: 435-224-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDD4486
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: