Provider Demographics
NPI:1902329097
Name:QUIRK, CARMEN ALLIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:ALLIE
Last Name:QUIRK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 E VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-5194
Mailing Address - Country:US
Mailing Address - Phone:931-526-1146
Mailing Address - Fax:
Practice Address - Street 1:755 E VETERANS DR
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-5194
Practice Address - Country:US
Practice Address - Phone:931-526-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY99951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics