MEDICARE: DR. AUSTIN GRANT O'QUINN 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	6896	LA

General Provider Information

NPI Number	:	1821582487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUSTIN GRANT O'QUINN DDS

Provider Business Mailing Address
First Line	:	2195 SUTHERLAND RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70611-3711
Country	:	US
Telephone Number	:	337-513-6120
Fax Number	:

Provider Business Practice Location Address
First Line	:	4750 NELSON RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5385
Country	:	US
Telephone Number	:	337-513-6120
Fax Number	:

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

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	06/18/2018

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