Active NPI
Eric L Quillen, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Versailles, KY
National Provider Identifier
1588774202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 653
- Practice address
- 156 Frankfort Street
Versailles, KY 40383 - Phone
- (859) 879-5045
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7449 | KY | |
| Dentist | 122300000X | 2241 | WV | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 653 | KY | Primary |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 59 | WV |
Addresses
Primary practice location
156 Frankfort Street
Versailles, KY 40383
Mailing address
156 Frankfort Street
Versailles, KY 40383
Phone (859) 879-5045
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60003100 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2241 | WV | MD | Mental Health Counselor |
| 7449 | KY | MD | Social Worker |
| 653 | KY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430697600000",
"number": "1588774202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "156 FRANKFORT STREET",
"city": "VERSAILLES",
"state": "KY",
"postal_code": "40383",
"telephone_number": "859-879-5045",
"fax_number": "859-879-5045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "156 FRANKFORT STREET",
"city": "VERSAILLES",
"state": "KY",
"postal_code": "40383",
"telephone_number": "859-879-5045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUILLEN",
"first_name": "ERIC",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2015-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "7449",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WV",
"license": "2241",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "KY",
"license": "653",
"primary": true
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "WV",
"license": "59",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60003100",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Versailles, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.