Provider Demographics
NPI:1639225782
Name:QUILLIAN, JONATHAN E (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:E
Last Name:QUILLIAN
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:E
Other - Last Name:QUILLIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, FAGD,PC
Mailing Address - Street 1:7915 CULEBRA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1443
Mailing Address - Country:US
Mailing Address - Phone:210-680-1550
Mailing Address - Fax:210-680-0004
Practice Address - Street 1:7915 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1443
Practice Address - Country:US
Practice Address - Phone:210-680-1550
Practice Address - Fax:210-680-0004
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice