Provider Demographics
NPI:1376726885
Name:QUINN STEPHANIE DENTAL GROUP, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:QUINN STEPHANIE DENTAL GROUP, PROFESSIONAL CORPORATION
Other - Org Name:STEPHANIE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-997-5958
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:175 N STEPHANIE ST
Practice Address - Street 2:STE 170
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8829
Practice Address - Country:US
Practice Address - Phone:702-997-5958
Practice Address - Fax:702-565-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty