Provider Demographics
NPI:1063088581
Name:QUIAO, JOHN-VINCENT (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN-VINCENT
Middle Name:
Last Name:QUIAO
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 1:3861 BRIARHILL ST
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1004
Mailing Address - Country:US
Mailing Address - Phone:914-434-1640
Mailing Address - Fax:
Practice Address - Street 1:122 PROFESSIONAL VIEW DR BLDG 100
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7902
Practice Address - Country:US
Practice Address - Phone:732-625-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028648001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry