# SAM W. QUILLEN JR. DMD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508131350
- **Authorized official:** DR. SAM WILEY QUILLEN JR. DMD (OWNER)
- **Authorized official phone:** (606) 855-7892

## Contact information

- **Practice address:** 861 HWY 317, SUITE A, NEON, KY 41840-0036
- **Practice address phone:** (606) 855-7892
- **Practice address fax:** (606) 855-7892
- **Mailing address:** PO BOX 36, SUITE A, NEON, KY 41840-0036
- **Mailing address phone:** (606) 855-7892
- **Mailing address fax:** (606) 855-7892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 4626 | KY | Yes |

## Other

- **Enumeration date:** 03/13/2012
- **Last updated:** 03/13/2012