Provider Demographics
NPI:1033994694
Name:QUIRT FAMILY DENTISTRY, S.C.
Entity Type:Organization
Organization Name:QUIRT FAMILY DENTISTRY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:1180 S CENTURY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-1827
Mailing Address - Country:US
Mailing Address - Phone:608-997-4002
Mailing Address - Fax:608-997-4004
Practice Address - Street 1:1180 S CENTURY AVE STE C
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-1827
Practice Address - Country:US
Practice Address - Phone:608-997-4002
Practice Address - Fax:608-997-4004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUIRT FAMILY DENTISTRY, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty