Provider Demographics
NPI:1245364462
Name:QUINLAN, JOHN J (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:QUINLAN
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 1:2550 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-6849
Mailing Address - Country:US
Mailing Address - Phone:920-434-3900
Mailing Address - Fax:
Practice Address - Street 1:2550 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-6849
Practice Address - Country:US
Practice Address - Phone:920-434-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2081G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice