Provider Demographics
NPI:1609178177
Name:RUPP, QUINTIN DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:QUINTIN
Middle Name:DAVID
Last Name:RUPP
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 1:12215 RAW SILVER
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5787
Mailing Address - Country:US
Mailing Address - Phone:435-224-3294
Mailing Address - Fax:
Practice Address - Street 1:5531 W LOOP 1604 N STE 115
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-7305
Practice Address - Country:US
Practice Address - Phone:210-293-0696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX264531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice