Organization
SAM W. QUILLEN JR. DMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAM WILEY QUILLEN JR. DMD (OWNER)
(606) 855-7892
Entity
Organization
Contact information
Practice address
861 HWY 317, SUITE A, NEON, KY 41840-0036
(606) 855-7892
(606) 855-7892
Mailing address
PO BOX 36, SUITE A, NEON, KY 41840-0036
(606) 855-7892
(606) 855-7892
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4626
KY
Other
Enumeration date
03/13/2012
Last updated
03/13/2012
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