Provider Demographics
NPI:1801654645
Name:DR CHARLES R QUINN II DDS LLC
Entity type:Organization
Organization Name:DR CHARLES R QUINN II DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRINCIPLE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-756-0957
Mailing Address - Street 1:651 E 4TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1932
Mailing Address - Country:US
Mailing Address - Phone:423-756-0957
Mailing Address - Fax:
Practice Address - Street 1:651 E 4TH ST STE 301
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1932
Practice Address - Country:US
Practice Address - Phone:423-756-0957
Practice Address - Fax:423-756-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment