Provider Demographics
NPI:1700079399
Name:QUILICHINI, CARLOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:QUILICHINI
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 1:4700 SW 160 TH AVENUE
Mailing Address - Street 2:APT 415
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:954-274-4027
Mailing Address - Fax:
Practice Address - Street 1:4700 SW 160TH AVE APT 415
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5716
Practice Address - Country:US
Practice Address - Phone:954-274-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00011673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist