Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 018.002194 | IL |
NPI | 1013546167 |
---|---|
Provider Name | Erik Nathaniel Quintana |
First Address | Urbana, IL 61801-2529 |
Second Address | Urbana, IL 61801-2529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2020 |
Last Update Date | 29/06/2021 |