Provider Demographics
NPI:1831106913
Name:QUARNSTROM, FRED CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:CARL
Last Name:QUARNSTROM
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 1:5767 S OAKLAWN PL
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3048
Mailing Address - Country:US
Mailing Address - Phone:206-329-0500
Mailing Address - Fax:206-722-2850
Practice Address - Street 1:3051 BEACON AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-5853
Practice Address - Country:US
Practice Address - Phone:206-329-0500
Practice Address - Fax:206-329-0538
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist