1689788689 NPI number — DR. ROBERT QUINTANO DDS

Table of content: DR. ROBERT QUINTANO DDS (NPI 1689788689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689788689 NPI number — DR. ROBERT QUINTANO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINTANO
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1689788689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46 OCEAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-6745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-393-8209
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 NORTHPORT AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
BELFAST
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04915-6002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-338-9307
Provider Business Practice Location Address Fax Number:
207-338-9331
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6083 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 760649708 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".




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