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General NPI Number Information
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NPI Number | 1760284855
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Entity Type | Individual
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Provider Name | ANTONIO DE JESUS QUIROZ BDS
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Gender | Male
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 635 ALBANY ST
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City | BOSTON
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State | MA
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Zip | 02118-3550
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Country | US
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Telephone | 214-403-3875
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Fax |
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Provider Business Mailing Address
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Address Line | 4 LUCY ST APT 312
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City | DORCHESTER
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State | MA
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Zip | 02125-2769
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Country | US
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Telephone | 214-403-3875
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DL100399
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License Number State | MA
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