Provider Demographics
NPI:1790862787
Name:QUINTANA, JANE B (DDS)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:B
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 SILVERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-7700
Mailing Address - Country:US
Mailing Address - Phone:919-496-3088
Mailing Address - Fax:
Practice Address - Street 1:122 JOLLY ST STE 103
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2272
Practice Address - Country:US
Practice Address - Phone:919-496-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8022OtherSTATE IDENTIFICATION NUMB