Healthcare Provider Details

I. General information

NPI: 1184756785
Provider Name (Legal Business Name): DENNIS P QUINLAN DDS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E LONGVIEW DR SUITE C
APPLETON WI
54911
US

IV. Provider business mailing address

420 E LONGVIEW DR SUITE C
APPLETON WI
54911
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-5082
  • Fax: 920-731-0282
Mailing address:
  • Phone: 920-731-5082
  • Fax: 920-731-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2385
License Number StateWI

VIII. Authorized Official

Name: DENNIS P QUINLAN
Title or Position: DENTIST OWNER
Credential: DDS
Phone: 920-731-5082