Provider Demographics
NPI:1730227414
Name:MARILOU D. QUIROZ DMD., INC
Entity type:Organization
Organization Name:MARILOU D. QUIROZ DMD., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:P
Authorized Official - Last Name:QUIROZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-395-4606
Mailing Address - Street 1:1392 E PALOMAR ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1893
Mailing Address - Country:US
Mailing Address - Phone:619-941-1820
Mailing Address - Fax:619-941-1821
Practice Address - Street 1:1392 E PALOMAR ST
Practice Address - Street 2:STE. 201
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1892
Practice Address - Country:US
Practice Address - Phone:619-941-1820
Practice Address - Fax:619-941-1821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA457601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty