MEDICARE: DR. GUILLERMO QUINONES D.M.D.

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	2409	PR

General Provider Information

NPI Number	:	1801891783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUILLERMO QUINONES D.M.D.

Provider Business Mailing Address
First Line	:	PLAZA SILVESTRE ER95 ENTRERIOS
Second Line	:	ER95
City	:	TRUJILLO ALTO
State	:	PR
Zip	:	00976
Country	:	US
Telephone Number	:	787-286-1644
Fax Number	:	787-286-1644

Provider Business Practice Location Address
First Line	:	HOSPITAL SAN JUAN BAUTISTA-CLINICAS EXTERNAS
Second Line	:	EXPRESO LUIS A. FERRE -SALIDA#21
City	:	CAGUAS
State	:	PR
Zip	:	00915
Country	:	US
Telephone Number	:	787-286-1644
Fax Number	:	787-286-1644

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	06/24/2008

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