Provider Demographics
NPI:1851408421
Name:QUINTERO, CONCEPCION C (DMD)
Entity Type:Individual
Prefix:DR
First Name:CONCEPCION
Middle Name:C
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 CAMINO DEL GUAMA
Mailing Address - Street 2:SABANERA DORADO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-3619
Mailing Address - Country:US
Mailing Address - Phone:787-626-6581
Mailing Address - Fax:787-626-6581
Practice Address - Street 1:BO. VEGA REDONDA,CARRETERA 778, SECTOR PASARELL
Practice Address - Street 2:PABELLON DE SERVICIOS
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782
Practice Address - Country:US
Practice Address - Phone:787-875-2190
Practice Address - Fax:787-875-2342
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD16451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD 1645OtherDELTA DENTAL
PRD000117OtherPLAN MENONITA
PR2240OtherINTL MEDICAL CARD
PR9610002OtherHUMANA PR
PR041358OtherCRUZ AZUL DE PR
PR41619OtherTRIPLE S
PR206008OtherPREFFERRED HEALTH