Provider Demographics
NPI:1902622665
Name:QUINTON POOLER DDS PLLC
Entity type:Organization
Organization Name:QUINTON POOLER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-654-2728
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental