Provider Demographics
NPI:1891117495
Name:QUIRT FAMILY DENTISTRY, SC
Entity Type:Organization
Organization Name:QUIRT FAMILY DENTISTRY, SC
Other - Org Name:PRAIRIE RIDGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:10288 77TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-1142
Mailing Address - Country:US
Mailing Address - Phone:262-612-3325
Mailing Address - Fax:
Practice Address - Street 1:10288 77TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1142
Practice Address - Country:US
Practice Address - Phone:262-612-3325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUIRT FAMILY DENTISTRY, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty