Provider Demographics
NPI:1013000678
Name:QUINGCO, ADELAIDA T (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADELAIDA
Middle Name:T
Last Name:QUINGCO
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 1:1127 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4002
Mailing Address - Country:US
Mailing Address - Phone:213-250-3998
Mailing Address - Fax:213-250-3999
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4002
Practice Address - Country:US
Practice Address - Phone:213-250-3998
Practice Address - Fax:213-250-3999
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA364171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice