Provider Demographics
NPI:1609945070
Name:QUINTERO, SARA V (DDS)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:V
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 S EUCLID ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-2079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1314 S EUCLID ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2079
Practice Address - Country:US
Practice Address - Phone:714-778-4605
Practice Address - Fax:714-778-4608
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821466OtherPROVIDER
CAG-92836-01OtherPROVIDER
CA521851OtherPIN