Basic Information
| Provider Information | |||||||||
| NPI: | 1992360895 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUIRINO | ||||||||
| FirstName: | GABRIELA | ||||||||
| MiddleName: | ANA | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5284 GEORGE CT APT C | ||||||||
| Address2: | |||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600316035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142092177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1137 INDEPENDENCE DR | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657754221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172558464 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2019 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1223G0001X | 1002518-15 | WI | Y | Dental Providers | Dentist | General Practice |
No ID Information.