Provider Demographics
NPI:1326687237
Name:TIMOTHY QUIRT, MONGRAIN, GIBREE, P.C.
Entity Type:Organization
Organization Name:TIMOTHY QUIRT, MONGRAIN, GIBREE, P.C.
Other - Org Name:ENSO DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CEMYIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-764-8609
Mailing Address - Street 1:15446 BEL RED RD STE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15446 BEL RED RD STE 100
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5503
Practice Address - Country:US
Practice Address - Phone:425-558-3676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIMOTHY QUIRT, MONGRAIN, GIBREE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-26
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty