Provider Demographics
NPI:1215096235
Name:QUINTANA, RAFAEL JUDAS (DMD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:JUDAS
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3410
Mailing Address - Country:US
Mailing Address - Phone:305-854-1721
Mailing Address - Fax:305-854-4344
Practice Address - Street 1:2438 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3410
Practice Address - Country:US
Practice Address - Phone:305-854-1721
Practice Address - Fax:305-854-4344
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00131541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice