Individual
ERICK QUINTANA RAYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-2411
Mailing address
2401 W ALTA RD APT 2102, PEORIA, IL 61615-4602
(815) 878-4033
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.032614
IL
Other
Enumeration date
06/25/2020
Last updated
06/25/2020
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