MEDICARE: DR. QUINTON M POOLER DDS

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	1223G0001X	General Practice Dentistry	27068	FL

General Provider Information

NPI Number	:	1336884212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QUINTON M POOLER DDS

Provider Business Mailing Address
First Line	:	12708 SAN JOSE BLVD STE 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-2600
Country	:	US
Telephone Number	:	904-268-0904
Fax Number	:

Provider Business Practice Location Address
First Line	:	12708 SAN JOSE BLVD STE 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-2600
Country	:	US
Telephone Number	:	904-268-0904
Fax Number	:

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

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	11/26/2024

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