Provider Demographics
NPI:1467946376
Name:QUIRT, MONGRAIN, GIBREE, P.C.
Entity Type:Organization
Organization Name:QUIRT, MONGRAIN, GIBREE, P.C.
Other - Org Name:HUES DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-6078
Mailing Address - Street 1:10025 19TH AVE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4275
Mailing Address - Country:US
Mailing Address - Phone:425-337-6885
Mailing Address - Fax:
Practice Address - Street 1:10025 19TH AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4275
Practice Address - Country:US
Practice Address - Phone:425-337-6885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUIRT, MONGRAIN, GIBREE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-15
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty