Provider Demographics
NPI:1982775458
Name:MICHAEL D. QUASHA DMD,PA
Entity Type:Organization
Organization Name:MICHAEL D. QUASHA DMD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:QUASHA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-799-5558
Mailing Address - Street 1:4520 DONALD ROSS RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-5105
Mailing Address - Country:US
Mailing Address - Phone:561-799-5558
Mailing Address - Fax:561-799-9311
Practice Address - Street 1:4520 DONALD ROSS RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-5105
Practice Address - Country:US
Practice Address - Phone:561-799-5558
Practice Address - Fax:561-799-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16005261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental