Provider Demographics
NPI:1609314368
Name:QUINTANA HIJANO, IVAN (DDS)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:QUINTANA HIJANO
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 1:11246 E MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3202
Mailing Address - Country:US
Mailing Address - Phone:303-344-0810
Mailing Address - Fax:303-344-5309
Practice Address - Street 1:11246 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3202
Practice Address - Country:US
Practice Address - Phone:303-344-0810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170022881223S0112X
CODEN.002044481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery