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NPI Code Detail

MEDICARE: DR. DAVID T. QUINN DMD

MEDICARE: DR. DAVID T. QUINN DMD
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
11223G0001XGeneral Practice DentistryD5261OR

General Provider Information

NPI Number : 1578568226
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID T. QUINN DMD
Provider Business Mailing Address
First Line : 222 SPARROW LN
Second Line :
City : GRANTS PASS
State : OR
Zip : 97526-8417
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8495 CRATER LAKE HWY
Second Line : DENTAL (160)
City : WHITE CITY
State : OR
Zip : 97503-3011
Country : US
Telephone Number : 541-830-7455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2005
Last Update Date : 08/31/2007

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