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General NPI Number Information
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NPI Number | 1780045773
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Entity Type | Organization
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Legal Business Name | QUINTANA SERRANO DENTAL, INC
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 5 CALLE BARBOSA SUITE 1
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City | ISABELA
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State | PR
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Zip | 00662-2901
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Country | US
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Telephone | 787-872-2046
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Fax | 787-830-5984
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Provider Business Mailing Address
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Address Line | 5 CALLE BARBOSA SUITE 1
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City | ISABELA
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State | PR
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Zip | 00662-2901
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Country | US
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Telephone | 787-872-2046
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Fax | 787-830-5984
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Authorized Official
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Title or Position | DENTIST
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Name | NICOLE QUINTANA
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Credential | DMD
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Telephone | 787-872-2046
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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 | 3161
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License Number State | PR
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