Provider Demographics
NPI:1205829900
Name:QUINN, WILLIAM JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
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 1:14687 34TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:ND
Mailing Address - Zip Code:58079-9512
Mailing Address - Country:US
Mailing Address - Phone:701-202-7075
Mailing Address - Fax:
Practice Address - Street 1:PRAIRIE ROSE FAMILY DENTISTS
Practice Address - Street 2:121 E. FRONT AVENUE
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504
Practice Address - Country:US
Practice Address - Phone:701-223-1194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND19761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice