Provider Demographics
NPI:1932535325
Name:QUINTANA, MELISSA (DMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:QUINTANA
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 1:107 NW 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1914
Mailing Address - Country:US
Mailing Address - Phone:305-898-5852
Mailing Address - Fax:
Practice Address - Street 1:107 NW 136TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-1914
Practice Address - Country:US
Practice Address - Phone:305-898-5852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist