Provider Demographics
NPI:1396293783
Name:ISMAEL QUINTINO
Entity type:Organization
Organization Name:ISMAEL QUINTINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISMAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-485-2566
Mailing Address - Street 1:1046 N VISTA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4167
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLVD. CUAUHTEMOC #11004-F.
Practice Address - Street 2:COL. LIBERTAD
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22400
Practice Address - Country:MX
Practice Address - Phone:909-485-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty