Provider Demographics
NPI:1356362156
Name:QUILLIN, FRANKLIN WEBSTER JR (DDS)
Entity type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:WEBSTER
Last Name:QUILLIN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:FRANKLIN
Other - Middle Name:W
Other - Last Name:QUILLIN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS PROF CORP
Mailing Address - Street 1:6171 CHILDERS RD
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:22504
Mailing Address - Country:US
Mailing Address - Phone:304-736-8906
Mailing Address - Fax:304-736-8961
Practice Address - Street 1:6171 CHILDERS RD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:22504
Practice Address - Country:US
Practice Address - Phone:304-736-8906
Practice Address - Fax:304-736-8961
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19471223P0221X
FL48041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0138600000Medicaid