Provider Demographics
NPI:1083492664
Name:QUINTERO FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:QUINTERO FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-718-8553
Mailing Address - Street 1:3193 BRIGHTON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2371
Mailing Address - Country:US
Mailing Address - Phone:407-718-8553
Mailing Address - Fax:
Practice Address - Street 1:547 EAST BRANNON RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356
Practice Address - Country:US
Practice Address - Phone:407-718-8553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty