Provider Demographics
NPI:1336884212
Name:POOLER, QUINTON M (DDS)
Entity type:Individual
Prefix:DR
First Name:QUINTON
Middle Name:M
Last Name:POOLER
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 1:12708 SAN JOSE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2600
Mailing Address - Country:US
Mailing Address - Phone:904-268-0904
Mailing Address - Fax:
Practice Address - Street 1:12708 SAN JOSE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2600
Practice Address - Country:US
Practice Address - Phone:904-268-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL270681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice