Provider Demographics
NPI:1205848090
Name:QUINN, KAYLEEN MICHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAYLEEN
Middle Name:MICHELLE
Last Name:QUINN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 SW 75TH ST APT S106
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7451
Mailing Address - Country:US
Mailing Address - Phone:352-682-4683
Mailing Address - Fax:
Practice Address - Street 1:430 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4433
Practice Address - Country:US
Practice Address - Phone:352-732-3425
Practice Address - Fax:352-732-4140
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDL17716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist