Healthcare Provider Details

I. General information

NPI: 1306207246
Provider Name (Legal Business Name): ANTHONY QUINTANA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N DUSTIN AVE
FARMINGTON NM
87401-6101
US

IV. Provider business mailing address

703 N DUSTIN AVE
FARMINGTON NM
87401-6101
US

V. Phone/Fax

Practice location:
  • Phone: 505-564-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4641
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: