Provider Demographics
NPI:1164632956
Name:QUINTERO, JOSE ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:QUINTERO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LANDRAU
Mailing Address - Street 2:CARR 21 # 1411
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-0000
Mailing Address - Country:US
Mailing Address - Phone:787-793-3095
Mailing Address - Fax:787-782-9368
Practice Address - Street 1:URB. LANDRAU
Practice Address - Street 2:CARR 21 # 1411
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-0000
Practice Address - Country:US
Practice Address - Phone:787-793-3095
Practice Address - Fax:787-782-9368
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR166661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR61666OtherMEDICAL CARD SYSTEM
PR41515OtherTRIPLE S
PR041268OtherCRUZ AZUL
PR9210078OtherHUMANA INSURANCE