Provider Demographics
NPI:1730305921
Name:TURK, AQUILLA SCOTT JR (DDS)
Entity Type:Individual
Prefix:
First Name:AQUILLA
Middle Name:SCOTT
Last Name:TURK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:QUILL
Other - Middle Name:
Other - Last Name:TURK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:9 ALISON AVENUE
Mailing Address - City:PANACEA
Mailing Address - State:FL
Mailing Address - Zip Code:32346-0459
Mailing Address - Country:US
Mailing Address - Phone:850-984-5384
Mailing Address - Fax:850-984-0467
Practice Address - Street 1:9 ALISON AVENUE
Practice Address - Street 2:
Practice Address - City:PANACEA
Practice Address - State:FL
Practice Address - Zip Code:32346-0459
Practice Address - Country:US
Practice Address - Phone:850-984-5384
Practice Address - Fax:850-984-0467
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6498122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist