Provider Demographics
NPI:1891958930
Name:DENTAQUEST, LLC
Entity Type:Organization
Organization Name:DENTAQUEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PROVIDER NETWORKS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-834-3553
Mailing Address - Street 1:12121 CORPORATE PKWY
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3332
Mailing Address - Country:US
Mailing Address - Phone:262-834-3553
Mailing Address - Fax:242-241-7366
Practice Address - Street 1:12121 CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3332
Practice Address - Country:US
Practice Address - Phone:262-834-3553
Practice Address - Fax:242-241-7366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization