Provider Demographics
NPI:1689411951
Name:QUINONEZ, JULISSA LISETT (DMD)
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:LISETT
Last Name:QUINONEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 BROOKHILL WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8672
Mailing Address - Country:US
Mailing Address - Phone:815-901-1170
Mailing Address - Fax:
Practice Address - Street 1:202 BALLENTRAE CT
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-5538
Practice Address - Country:US
Practice Address - Phone:984-400-9564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC138761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice