Provider Demographics
NPI:1891783007
Name:QUILLIN, DIANA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:L
Last Name:QUILLIN
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 1:7435 WESTCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-5210
Mailing Address - Country:US
Mailing Address - Phone:316-371-9908
Mailing Address - Fax:316-371-9908
Practice Address - Street 1:15922 STRATHERN ST STE 18
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1315
Practice Address - Country:US
Practice Address - Phone:866-988-4504
Practice Address - Fax:866-988-4504
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist