Provider Demographics
NPI:1639692908
Name:QUINTIN TODD JULIUS, PLLC
Entity Type:Organization
Organization Name:QUINTIN TODD JULIUS, PLLC
Other - Org Name:SIWELL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUINTIN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JULIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-371-8634
Mailing Address - Street 1:6745 S SIWELL RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-8746
Mailing Address - Country:US
Mailing Address - Phone:601-371-8634
Mailing Address - Fax:601-371-8724
Practice Address - Street 1:6745 S. SIWELL RD.
Practice Address - Street 2:SUITE 210
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272
Practice Address - Country:US
Practice Address - Phone:601-371-8634
Practice Address - Fax:601-371-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS34451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0178507Medicaid