Provider Demographics
NPI:1679271324
Name:DENTAL PROFESSIONALS OF WASHINGTON, QUIRT, MONGRAIN, GIBREE, PC
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF WASHINGTON, QUIRT, MONGRAIN, GIBREE, PC
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 1:15514 MERIDIAN E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-9513
Mailing Address - Country:US
Mailing Address - Phone:253-268-1215
Mailing Address - Fax:253-268-1213
Practice Address - Street 1:15514 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9513
Practice Address - Country:US
Practice Address - Phone:253-268-1215
Practice Address - Fax:253-268-1213
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF WASHINGTON, QUIRT, MONGRAIN, GIBREE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty