Provider Demographics
NPI:1104963768
Name:QUIST, HAROLD JR (DDS)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:QUIST
Suffix:JR
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 1:2 N MAIN ST
Mailing Address - Street 2:STE 405
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6318
Mailing Address - Country:US
Mailing Address - Phone:307-672-7439
Mailing Address - Fax:
Practice Address - Street 1:2 N MAIN ST
Practice Address - Street 2:STE 405
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6318
Practice Address - Country:US
Practice Address - Phone:307-672-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice