Provider Demographics
NPI:1821582487
Name:O'QUINN, AUSTIN GRANT (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:GRANT
Last Name:O'QUINN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 SUTHERLAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-3711
Mailing Address - Country:US
Mailing Address - Phone:337-513-6120
Mailing Address - Fax:
Practice Address - Street 1:4750 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5385
Practice Address - Country:US
Practice Address - Phone:337-513-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist