Provider Demographics
NPI:1417939091
Name:QUAYNOR, BENJAMIN O (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:O
Last Name:QUAYNOR
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 1:707 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1610
Mailing Address - Country:US
Mailing Address - Phone:314-367-2566
Mailing Address - Fax:314-454-1675
Practice Address - Street 1:707 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1610
Practice Address - Country:US
Practice Address - Phone:314-367-2566
Practice Address - Fax:314-454-1675
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO013067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist