Provider Demographics
NPI:1871816686
Name:QUINTANA CASTRILLON, YVAN CARLOS (DDS)
Entity Type:Individual
Prefix:
First Name:YVAN
Middle Name:CARLOS
Last Name:QUINTANA CASTRILLON
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 1:2693 FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4524
Mailing Address - Country:US
Mailing Address - Phone:916-424-5500
Mailing Address - Fax:916-424-7634
Practice Address - Street 1:2693 FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-4524
Practice Address - Country:US
Practice Address - Phone:916-424-5500
Practice Address - Fax:916-424-7634
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA591571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice