Provider Demographics
NPI:1033891809
Name:QUAN, MICHELLE (DDS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:QUAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 E CARONDELET DR STE 355
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3523
Mailing Address - Country:US
Mailing Address - Phone:520-733-9225
Mailing Address - Fax:
Practice Address - Street 1:6565 E CARONDELET DR STE 355
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3523
Practice Address - Country:US
Practice Address - Phone:520-733-9225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IND0123021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice