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General NPI Number Information
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NPI Number | 1174911283
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Entity Type | Organization
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Legal Business Name | DR. YVAN QUINTANA DDS INC.
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Dates
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Enumeration Date | 12/26/2014
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Last Update Date | 12/26/2014
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Provider Practice Location Address
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Address Line | 295 E ST SUITE C
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City | WILLIAMS
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State | CA
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Zip | 95987-5813
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Country | US
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Telephone | 530-501-4530
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Fax |
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Provider Business Mailing Address
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Address Line | 295 E ST SUITE C
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City | WILLIAMS
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State | CA
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Zip | 95987-5813
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Country | US
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Telephone | 530-501-4530
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. YVAN QUINTANA
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Credential | DDS
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Telephone | 916-799-6073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 59157
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License Number State | CA
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