MEDICARE: BRIAN QUAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DI03083300	NJ

General Provider Information

NPI Number	:	1235839903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN QUAN

Provider Business Mailing Address
First Line	:	1033 RIVER RD
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1351
Country	:	US
Telephone Number	:	201-224-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1033 RIVER RD
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1351
Country	:	US
Telephone Number	:	201-224-0900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	01/21/2026

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Directions to “ BRIAN QUAN ” Practice Location

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