Provider Demographics
NPI:1871994723
Name:QUINCY DENTAL CENTER
Entity type:Organization
Organization Name:QUINCY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:PRITTS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-224-0426
Mailing Address - Street 1:332 S 36TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5808
Mailing Address - Country:US
Mailing Address - Phone:217-224-0426
Mailing Address - Fax:217-224-1402
Practice Address - Street 1:332 S 36TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-5808
Practice Address - Country:US
Practice Address - Phone:217-224-0426
Practice Address - Fax:217-224-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-027702261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental