Provider Demographics
NPI:1023215928
Name:QANTAQUA, DAN P
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:P
Last Name:QANTAQUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PRESTIGE DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-9503
Mailing Address - Country:US
Mailing Address - Phone:315-462-2175
Mailing Address - Fax:
Practice Address - Street 1:80 PRESTIGE DR
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-9503
Practice Address - Country:US
Practice Address - Phone:315-462-2175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other