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General NPI Number Information
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NPI Number | 1316120033
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Entity Type | Organization
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Legal Business Name | QUINCY ORAL & MAXILLOFACIAL SURGERY, P.C.
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 3915 MAINE ST SUITE 3
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City | QUINCY
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State | IL
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Zip | 62305-5843
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Country | US
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Telephone | 217-222-9434
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Fax | 217-222-0671
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Provider Business Mailing Address
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Address Line | 3915 MAINE ST SUITE 3
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City | QUINCY
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State | IL
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Zip | 62305-5843
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Country | US
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Telephone | 217-222-9434
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Fax | 217-222-0671
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DANIEL RIGGS
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Credential |
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Telephone | 217-222-9434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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