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General NPI Number Information
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NPI Number | 1467937367
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Entity Type | Organization
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Legal Business Name | QUAILHEARST CORP
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 2775 PARK MARINA DR STE A
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City | REDDING
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State | CA
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Zip | 96001-2840
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Country | US
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Telephone | 530-949-8221
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 71076
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City | SHASTA LAKE
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State | CA
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Zip | 96079-1076
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Country | US
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Telephone | 530-949-8221
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LYNNI MILLER
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Credential | RDH
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Telephone | 530-949-8221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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