Provider Demographics
NPI:1093004921
Name:NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.
Entity Type:Organization
Organization Name:NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.
Other - Org Name:DENTAL CARE AT CRYSTAL PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5141
Mailing Address - Street 1:2231 CRYSTAL DR LBBY 150
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3781
Mailing Address - Country:US
Mailing Address - Phone:703-892-0883
Mailing Address - Fax:703-892-0885
Practice Address - Street 1:2231 CRYSTAL DR LBBY 150
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3781
Practice Address - Country:US
Practice Address - Phone:703-892-0883
Practice Address - Fax:703-892-0885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-31
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty