Provider Demographics
NPI:1669795654
Name:QUARTEY-SAGAILLE, TRICIA (DMD)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:QUARTEY-SAGAILLE
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 1:472 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4004
Mailing Address - Country:US
Mailing Address - Phone:718-965-1144
Mailing Address - Fax:
Practice Address - Street 1:472 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4004
Practice Address - Country:US
Practice Address - Phone:718-965-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02432100122300000X
NY055308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist