Provider Demographics
NPI:1346692308
Name:JORGE E. QUINTERO
Entity Type:Organization
Organization Name:JORGE E. QUINTERO
Other - Org Name:EXCLUSIVE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-658-4060
Mailing Address - Street 1:5143 BEACH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-3133
Mailing Address - Country:US
Mailing Address - Phone:407-461-4187
Mailing Address - Fax:
Practice Address - Street 1:250 N ALAFAYA TRL
Practice Address - Street 2:STE 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21904122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty