Provider Demographics
NPI:1780045773
Name:QUINTANA SERRANO DENTAL, INC
Entity Type:Organization
Organization Name:QUINTANA SERRANO DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-872-2046
Mailing Address - Street 1:5 CALLE BARBOSA
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2901
Mailing Address - Country:US
Mailing Address - Phone:787-872-2046
Mailing Address - Fax:787-830-5984
Practice Address - Street 1:5 CALLE BARBOSA
Practice Address - Street 2:SUITE 1
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2901
Practice Address - Country:US
Practice Address - Phone:787-872-2046
Practice Address - Fax:787-830-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty