MEDICARE: QUEST DENTAL MANAGEMENT

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1740456425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEST DENTAL MANAGEMENT

Provider Business Mailing Address
First Line	:	1821 N ZARAGOZA RD # 642
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7912
Country	:	US
Telephone Number	:	915-241-5622
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 JUAN ESCUTIA NTE
Second Line	:
City	:	CD. JUAREZ
State	:	CHIHUAHUA
Zip	:	32300
Country	:	MX
Telephone Number	:	526566163402
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LAURA E HAYS
Credential	:
Telephone Number	:	915-241-5622

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	05/02/2008

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Directions to “QUEST DENTAL MANAGEMENT ” Practice Location

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