Provider Demographics
NPI:1275985368
Name:QUINN, SHANKEERTHA S (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHANKEERTHA
Middle Name:S
Last Name:QUINN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHANKEERTHA
Other - Middle Name:
Other - Last Name:SUNDARALINGAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:12667 BEACH BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7346
Mailing Address - Country:US
Mailing Address - Phone:904-204-1542
Mailing Address - Fax:904-683-0359
Practice Address - Street 1:12667 BEACH BLVD STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7346
Practice Address - Country:US
Practice Address - Phone:904-204-1542
Practice Address - Fax:904-683-0359
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 22098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist