# K Q DENTAL PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Pine Lake Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194897058
- **Authorized official:** DR. EDWARD E. QUINCY D.D.S. (PRESIDENT)
- **Authorized official phone:** (402) 447-6042

## Contact information

- **Practice address:** 2504 NORTH WEBB RD, GRAND ISLAND, NE 68803
- **Practice address phone:** (308) 381-7077
- **Practice address fax:** (308) 381-1345
- **Mailing address:** PO BOX 87, NEWMAN GROVE, NE 68758

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3376 | NE | — |
| 1223G0001X | General Practice Dentistry | 3530 | NE | — |
| 1223G0001X | General Practice Dentistry | 4467 | NE | — |
| 1223G0001X | General Practice Dentistry | 4543 | NE | — |
| 1223G0001X | General Practice Dentistry | 5343 | NE | — |
| 1223G0001X | General Practice Dentistry | 5746 | NE | — |
| 1223G0001X | General Practice Dentistry | 5838 | NE | — |
| 1223G0001X | General Practice Dentistry | 5954 | NE | — |
| 1223G0001X | General Practice Dentistry | 5962 | NE | — |
| 1223G0001X | General Practice Dentistry | 6365 | NE | — |
| 1223G0001X | General Practice Dentistry | 6759 | NE | — |
| 1223G0001X | General Practice Dentistry | 6834 | NE | Yes |
| 1223G0001X | General Practice Dentistry | 6837 | — | — |

## Other

- **Enumeration date:** 11/15/2006
- **Last updated:** 07/06/2009