Provider Demographics
NPI:1710692223
Name:SMITH, QUINTON
Entity Type:Individual
Prefix:
First Name:QUINTON
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 W 78TH ST APT 1106
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-4629
Mailing Address - Country:US
Mailing Address - Phone:918-350-1266
Mailing Address - Fax:
Practice Address - Street 1:1415 W 78TH ST APT 1106
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-4629
Practice Address - Country:US
Practice Address - Phone:918-350-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171WH0202XOther Service ProvidersContractorHome Modifications