Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0401413373 | VA |
NPI | 1003191859 |
---|---|
Provider Name | Luis Fernando Quiros |
First Address | Smithfield, VA 23430-7117 |
Second Address | Smithfield, VA 23430-7117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2011 |
Last Update Date | 24/04/2018 |