Basic Information
Provider Information
NPI: 1316120033
EntityType: 2
ReplacementNPI:  
OrganizationName: QUINCY ORAL & MAXILLOFACIAL SURGERY, P.C.
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Mailing Information
Address1: 3915 MAINE ST
Address2: SUITE 3
City: QUINCY
State: IL
PostalCode: 623055843
CountryCode: US
TelephoneNumber: 2172229434
FaxNumber: 2172220671
Practice Location
Address1: 3915 MAINE ST
Address2: SUITE 3
City: QUINCY
State: IL
PostalCode: 623055843
CountryCode: US
TelephoneNumber: 2172229434
FaxNumber: 2172220671
Other Information
ProviderEnumerationDate: 12/17/2007
LastUpdateDate: 08/22/2008
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AuthorizedOfficialLastName: RIGGS
AuthorizedOfficialFirstName: DANIEL
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AuthorizedOfficialTitleorPosition: VICE-PRESIDENT
AuthorizedOfficialTelephone: 2172229434
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IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223S0112X  Y193400000X SINGLE SPECIALTY GROUPDental ProvidersDentistOral and Maxillofacial Surgery

No ID Information.


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