Provider Demographics
NPI:1033678875
Name:QUIRT FAMILY DENTISTRY, S.C.
Entity Type:Organization
Organization Name:QUIRT FAMILY DENTISTRY, S.C.
Other - Org Name:DENTAL CARE OF WAUKESHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8426
Mailing Address - Street 1:701 E SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7715
Mailing Address - Country:US
Mailing Address - Phone:262-565-6304
Mailing Address - Fax:
Practice Address - Street 1:701 E SUNSET DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7715
Practice Address - Country:US
Practice Address - Phone:262-290-5579
Practice Address - Fax:262-922-4436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUIRT FAMILY DENTISTRY, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-19
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty