Provider Demographics
NPI:1477622850
Name:O'QUINN, JULIE ANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANNA
Last Name:O'QUINN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ANNA
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:121 W LLANO ESTACADO BLVD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3712
Mailing Address - Country:US
Mailing Address - Phone:505-742-3100
Mailing Address - Fax:505-742-3400
Practice Address - Street 1:121 W LLANO ESTACADO BLVD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3712
Practice Address - Country:US
Practice Address - Phone:505-742-3100
Practice Address - Fax:505-742-3400
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD18871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice