Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 1001094-15 | WI |
NPI | 1639564784 |
---|---|
Provider Name | Dr. Tyler Quinn |
First Address | San Diego, CA 92134-0001 |
Second Address | San Diego, CA 92134-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2015 |
Last Update Date | 16/07/2015 |