1003026592 NPI number — ADVANCED DENTISTRY SERVICES LLC

Table of content: DR. TIMOTHY ROBERT QUINER M.D. (NPI 1912989575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003026592 NPI number — ADVANCED DENTISTRY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED DENTISTRY SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003026592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3337 N. MILLER RD.
Provider Second Line Business Mailing Address:
SUITE #108
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-945-4700
Provider Business Mailing Address Fax Number:
480-945-4707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3337 N. MILLER ROAD
Provider Second Line Business Practice Location Address:
SUITE #108
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-945-4700
Provider Business Practice Location Address Fax Number:
480-945-4707
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HLEBAK
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-945-4700

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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