Provider Demographics
NPI:1134687379
Name:GQ DENTAL CLINIC P.S.C.
Entity Type:Organization
Organization Name:GQ DENTAL CLINIC P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-647-0070
Mailing Address - Street 1:PO BOX 961
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0961
Mailing Address - Country:US
Mailing Address - Phone:787-647-0070
Mailing Address - Fax:
Practice Address - Street 1:MARINA PLAZA SUITE 16
Practice Address - Street 2:BARRIO RINCON
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-0961
Practice Address - Country:US
Practice Address - Phone:787-737-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2409OtherLICENSE NUMBER