Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4533 | WA |
NPI | 1033194063 |
---|---|
Provider Name | Dr. Richard Scott Quinn |
First Address | Renton, WA 98055-5108 |
Second Address | Renton, WA 98055-5108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 08/07/2007 |