Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 10556 | MD |
NPI | 1013039692 |
---|---|
Provider Name | Bartley Thomas Quillin |
First Address | Salisbury, MD 21801-7130 |
Second Address | Salisbury, MD 21801-7130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |