Provider Demographics
NPI:1710143110
Name:QUIRAM DENTAL, PSC
Entity Type:Organization
Organization Name:QUIRAM DENTAL, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:QUIRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-534-3127
Mailing Address - Street 1:338 W BROADWAY
Mailing Address - Street 2:PO BOX 518
Mailing Address - City:PLAINVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55964-1256
Mailing Address - Country:US
Mailing Address - Phone:507-534-3127
Mailing Address - Fax:507-534-2990
Practice Address - Street 1:338 W BROADWAY
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:MN
Practice Address - Zip Code:55964-1256
Practice Address - Country:US
Practice Address - Phone:507-534-3127
Practice Address - Fax:507-534-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMND10446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN63282290Medicaid