Provider Demographics
NPI:1003191859
Name:QUIROS, LUIS FERNANDO (DDS)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:FERNANDO
Last Name:QUIROS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12746 COURTHOUSE HWY
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-7117
Mailing Address - Country:US
Mailing Address - Phone:757-357-6779
Mailing Address - Fax:757-357-2722
Practice Address - Street 1:12746 COURTHOUSE HWY
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-7117
Practice Address - Country:US
Practice Address - Phone:757-357-6779
Practice Address - Fax:757-357-2722
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist