Provider Demographics
NPI:1255616561
Name:QUANLI DONG DDS INC
Entity type:Organization
Organization Name:QUANLI DONG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:QUANLI
Authorized Official - Middle Name:
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-755-7573
Mailing Address - Street 1:355 GELLERT BLVD
Mailing Address - Street 2:SUITE 152
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 GELLERT BLVD
Practice Address - Street 2:SUITE 152
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2665
Practice Address - Country:US
Practice Address - Phone:650-755-7573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54137261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental