Provider Demographics
NPI:1689970576
Name:NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.
Entity Type:Organization
Organization Name:NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.
Other - Org Name:ELAN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:2931 N TENAYA WAY STE 206
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0458
Mailing Address - Country:US
Mailing Address - Phone:702-228-7575
Mailing Address - Fax:702-240-6373
Practice Address - Street 1:2931 N TENAYA WAY STE 206
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0458
Practice Address - Country:US
Practice Address - Phone:702-228-7575
Practice Address - Fax:702-240-6373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-10
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty