Provider Demographics
NPI:1144205048
Name:QUILICI, DIANA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:L
Last Name:QUILICI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 ARNOLD AVE
Mailing Address - Street 2:BUILDING 88
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-1018
Mailing Address - Country:US
Mailing Address - Phone:916-561-7808
Mailing Address - Fax:916-561-7835
Practice Address - Street 1:5401 ARNOLD AVE
Practice Address - Street 2:BUILDING 88
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-1018
Practice Address - Country:US
Practice Address - Phone:916-561-7808
Practice Address - Fax:916-561-7835
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist