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General NPI Number Information
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NPI Number | 1275985368
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Entity Type | Individual
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Provider Name | SHANKEERTHA S QUINN D.M.D
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Gender | Female
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 12667 BEACH BLVD STE 103
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7346
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Country | US
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Telephone | 904-204-1542
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Fax | 904-683-0359
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Provider Business Mailing Address
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Address Line | 12667 BEACH BLVD STE 103
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7346
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Country | US
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Telephone | 904-204-1542
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Fax | 904-683-0359
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN 22098
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License Number State | FL
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