Provider Demographics
NPI:1629118393
Name:QUINN, CAROL J (DDS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:QUINN
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 1:21024 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1334
Mailing Address - Country:US
Mailing Address - Phone:313-881-1231
Mailing Address - Fax:313-886-1122
Practice Address - Street 1:21024 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1334
Practice Address - Country:US
Practice Address - Phone:313-881-1231
Practice Address - Fax:313-886-1122
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010135411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice