Provider Demographics
NPI:1538431903
Name:QUINTANA DENTAL PRACTICE
Entity type:Organization
Organization Name:QUINTANA DENTAL PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-292-8300
Mailing Address - Street 1:8501 CANDELARIA RD NE
Mailing Address - Street 2:C-1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1034
Mailing Address - Country:US
Mailing Address - Phone:505-292-8300
Mailing Address - Fax:505-332-4335
Practice Address - Street 1:8501 CANDELARIA RD NE
Practice Address - Street 2:C-1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1034
Practice Address - Country:US
Practice Address - Phone:505-292-8300
Practice Address - Fax:505-332-4335
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUINTANA DENTAL PRACTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty