Provider Demographics
NPI:1811103385
Name:QUAN, RICHARD EDGAR (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDGAR
Last Name:QUAN
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 1:3151 S WHITE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-4045
Mailing Address - Country:US
Mailing Address - Phone:408-274-8558
Mailing Address - Fax:408-274-8611
Practice Address - Street 1:3151 S WHITE RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-4045
Practice Address - Country:US
Practice Address - Phone:408-274-8558
Practice Address - Fax:408-274-8611
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics