=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992820393
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUINN DENTAL P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3938 CEDAR GROVE PKWY
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55122-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-452-9660
-----------------------------------------------------
Fax | 651-406-8544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3938 CEDAR GROVE PKWY
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55122-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-452-9660
-----------------------------------------------------
Fax | 651-406-8544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DONALD ARTHUR QUINN JR.
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 651-452-9660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 8042
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------