MEDICARE: DONALD THOMAS QUIGLEY 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	122300000X	Dentist	11025	TX

General Provider Information

NPI Number	:	1548398043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD THOMAS QUIGLEY DDS

Provider Business Mailing Address
First Line	:	15068 SAN PEDRO AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15068 SAN PEDRO AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3714
Country	:	US
Telephone Number	:	210-494-7681
Fax Number	:

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	09/06/2023

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