Healthcare Provider Details

I. General information

NPI: 1164632956
Provider Name (Legal Business Name): JOSE ANTONIO QUINTERO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. LANDRAU CARR 21 # 1411
SAN JUAN PR
00921-0000
US

IV. Provider business mailing address

URB. LANDRAU CARR 21 # 1411
SAN JUAN PR
00921-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-793-3095
  • Fax: 787-782-9368
Mailing address:
  • Phone: 787-793-3095
  • Fax: 787-782-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16666
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: