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General NPI Number Information
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NPI Number | 1861644932
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Entity Type | Individual
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Provider Name | MATTHEW QUILLEN D.D.S
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Gender | Male
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 221 ISLAND AVE
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City | SAN DIEGO
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State | CA
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Zip | 92101-6936
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Country | US
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Telephone | 646-510-0345
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Fax |
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Provider Business Mailing Address
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Address Line | 221 ISLAND AVE
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City | SAN DIEGO
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State | CA
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Zip | 92101-6936
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Country | US
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Telephone |
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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 | 054220
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License Number State | NY
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