Provider Demographics
NPI:1780761122
Name:QUIEC, CHARLYN (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLYN
Middle Name:
Last Name:QUIEC
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 1:139 E COLORADO BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2803
Mailing Address - Country:US
Mailing Address - Phone:626-599-9818
Mailing Address - Fax:626-599-9812
Practice Address - Street 1:139 E COLORADO BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2803
Practice Address - Country:US
Practice Address - Phone:626-599-9818
Practice Address - Fax:626-599-9812
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice