Provider Demographics
NPI:1194897058
Name:K Q DENTAL PC
Entity type:Organization
Organization Name:K Q DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUINCY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-447-6042
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:NEWMAN GROVE
Mailing Address - State:NE
Mailing Address - Zip Code:68758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2504 NORTH WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-381-7077
Practice Address - Fax:308-381-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE59621223G0001X
NE59541223G0001X
NE33761223G0001X
NE57461223G0001X
NE35301223G0001X
NE63651223G0001X
NE45431223G0001X
NE53431223G0001X
NE44671223G0001X
NE58381223G0001X
NE67591223G0001X
NE68341223G0001X
68371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========04Medicaid
NE=========31Medicaid
NE=========06Medicaid
NE=========05Medicaid
NE=========03Medicaid
NE=========13Medicaid
NE=========20Medicaid
NE=========17Medicaid