Provider Demographics
NPI:1104216811
Name:QUILLING-DAVIS, BRENDA JEAN (RDH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JEAN
Last Name:QUILLING-DAVIS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30400 NE IRELAND RD
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9606
Mailing Address - Country:US
Mailing Address - Phone:360-989-6065
Mailing Address - Fax:360-834-0508
Practice Address - Street 1:30400 NE IRELAND RD
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-9606
Practice Address - Country:US
Practice Address - Phone:360-989-6065
Practice Address - Fax:360-834-0508
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIL 60433058124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist