Provider Demographics
NPI:1154642288
Name:QUINLAN-SCARBOROUGH, AMBER LEAH
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEAH
Last Name:QUINLAN-SCARBOROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 14TH STREET
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913
Mailing Address - Country:US
Mailing Address - Phone:608-356-6611
Mailing Address - Fax:
Practice Address - Street 1:880 14TH STREET
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913
Practice Address - Country:US
Practice Address - Phone:608-356-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6681-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist