Provider Demographics
NPI:1235386020
Name:QUINTERO, JORGE EDUARDO (DDS)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:EDUARDO
Last Name:QUINTERO
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 1:250 N ALAFAYA TRL
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4315
Mailing Address - Country:US
Mailing Address - Phone:407-658-4060
Mailing Address - Fax:407-658-4062
Practice Address - Street 1:250 N ALAFAYA TRL
Practice Address - Street 2:125
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4315
Practice Address - Country:US
Practice Address - Phone:407-658-4060
Practice Address - Fax:407-658-4062
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist