MEDICARE: DR. MARGARET ANN QUILLER 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	105293	CO

General Provider Information

NPI Number	:	1528069028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGARET ANN QUILLER DDS

Provider Business Mailing Address
First Line	:	PO BOX 4000
Second Line	:	HOPI HEALTHCARE CENTER
City	:	POLACCA
State	:	AZ
Zip	:	80642-0642
Country	:	US
Telephone Number	:	928-737-6000
Fax Number	:	928-737-6168

Provider Business Practice Location Address
First Line	:	HIGHWAY 264, MP 388
Second Line	:
City	:	POLACCA
State	:	AZ
Zip	:	86042-6042
Country	:	US
Telephone Number	:	928-737-6000
Fax Number	:	928-737-6168

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/15/2012

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