Provider Demographics
NPI:1417269432
Name:QUINN, PATRICK RYAN (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:RYAN
Last Name:QUINN
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:PO BOX 11949
Mailing Address - Street 2:1717 S. CALHOUN ST.
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46862
Mailing Address - Country:US
Mailing Address - Phone:260-458-2641
Mailing Address - Fax:260-458-3093
Practice Address - Street 1:1717 S. CALHOUN ST.
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46862
Practice Address - Country:US
Practice Address - Phone:260-458-2641
Practice Address - Fax:260-458-3093
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011475A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist