Provider Demographics
NPI:1821014382
Name:NEVADA DENTAL PROFESSIONAL, QUIRT, GATES, PC
Entity Type:Organization
Organization Name:NEVADA DENTAL PROFESSIONAL, QUIRT, GATES, PC
Other - Org Name:GALLERIA 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 1:1399 GALLERIA DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6664
Mailing Address - Country:US
Mailing Address - Phone:702-433-0007
Mailing Address - Fax:702-435-4618
Practice Address - Street 1:1399 GALLERIA DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6664
Practice Address - Country:US
Practice Address - Phone:702-433-0007
Practice Address - Fax:702-435-4618
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA DENTAL PROFESSIONAL,QUIRT,GATES,P
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-15
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty