Provider Demographics
NPI:1144215740
Name:QUINN, STEVEN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:P
Last Name:QUINN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 E MONTCLAIR ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5076
Mailing Address - Country:US
Mailing Address - Phone:417-887-8800
Mailing Address - Fax:417-887-6265
Practice Address - Street 1:1103 E MONTCLAIR ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5076
Practice Address - Country:US
Practice Address - Phone:417-887-8800
Practice Address - Fax:417-887-6265
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01456541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
15376OtherBC/S MEDICAL
19000578OtherRR MEDICARE
882645OtherUNITED CONCORDIA
11245OtherBC/S DENTAL
14564OtherDELTA
15376OtherBLUE CHOICE
14564OtherDELTA TRICARE
11245OtherBC/S DENTAL
14564OtherDELTA TRICARE