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General NPI Number Information
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NPI Number | 1275058919
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Entity Type | Organization
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Legal Business Name | ANTHONY T QUINTA DMD LLC
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1795 MAIN STREET SUITE 202
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City | SPRINGFIELD
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State | MA
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Zip | 01103
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Country | US
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Telephone | 413-739-5685
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Fax |
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Provider Business Mailing Address
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Address Line | 1795 MAIN ST STE 202
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City | SPRINGFIELD
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State | MA
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Zip | 01103-1015
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Country | US
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Telephone | 413-739-5685
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Fax | 413-737-8209
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ANTHONY QUINTA
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Credential | DMD
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Telephone | 508-245-4288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN1855406
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License Number State | MA
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