Provider Demographics
NPI:1275594681
Name:NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.
Entity Type:Organization
Organization Name:NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.
Other - Org Name:SUNSTONE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CRED. SUP.
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5170
Mailing Address - Street 1:1701 N. GREEN VALLEY PARKWAY
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89017-5989
Mailing Address - Country:US
Mailing Address - Phone:702-837-6555
Mailing Address - Fax:702-263-7639
Practice Address - Street 1:1701 N. GREEN VALLEY PARKWAY
Practice Address - Street 2:SUITE 7A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89017-5989
Practice Address - Country:US
Practice Address - Phone:702-837-6555
Practice Address - Fax:702-263-7639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-28
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty