MEDICARE: DR. DANIEL QUON D.M.D.

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	1849-79	MS
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	1849-79	MS

General Provider Information

NPI Number	:	1275536252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL QUON D.M.D.

Provider Business Mailing Address
First Line	:	5800 RIDGEWOOD RD
Second Line	:	STE 102
City	:	JACKSON
State	:	MS
Zip	:	39211-2667
Country	:	US
Telephone Number	:	601-957-1207
Fax Number	:	601-957-0602

Provider Business Practice Location Address
First Line	:	5800 RIDGEWOOD RD
Second Line	:	STE 102
City	:	JACKSON
State	:	MS
Zip	:	39211-2667
Country	:	US
Telephone Number	:	601-957-1207
Fax Number	:	601-957-0602

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/06/2015

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