Provider Demographics
NPI:1215090253
Name:QUINN, PATRICK VINCENT (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:VINCENT
Last Name:QUINN
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 1:1 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8022
Mailing Address - Country:US
Mailing Address - Phone:406-442-2727
Mailing Address - Fax:406-442-1219
Practice Address - Street 1:1 MEDICAL PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8022
Practice Address - Country:US
Practice Address - Phone:406-442-2727
Practice Address - Fax:406-442-1219
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0113441Medicaid
MT5512845OtherCHIP PROVIDER NUMBER