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General NPI Number Information
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NPI Number | 1386091791
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Entity Type | Individual
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Provider Name | INES QUINTANILLA
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Gender | Male
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 15530 W 64TH AVE UNIT H
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City | ARVADA
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State | CO
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Zip | 80007-6874
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Country | US
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Telephone | 303-422-3746
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Fax |
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Provider Business Mailing Address
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Address Line | 2618 S HIGH ST
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City | DENVER
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State | CO
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Zip | 80210-5937
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Country | US
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Telephone | 281-844-7236
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Fax |
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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 | 32469
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 21898304
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN.00203453
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License Number State | CO
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