Provider Demographics
NPI:1114679156
Name:DR QUINTANA DENTAL CORPORATION INC
Entity Type:Organization
Organization Name:DR QUINTANA DENTAL CORPORATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YVAN CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA CASTRILLON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-799-6073
Mailing Address - Street 1:361 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-6829
Mailing Address - Country:US
Mailing Address - Phone:530-230-9555
Mailing Address - Fax:
Practice Address - Street 1:361 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-6829
Practice Address - Country:US
Practice Address - Phone:530-230-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental