Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 057383 | NY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 276236 | NY |
NPI | 1114187762 |
---|---|
Provider Name | Dr. Yandresco Quintana |
First Address | New York, NY 10033-4802 |
Second Address | New York, NY 10033-4802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 21/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04345231 | (05) | NY |