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General NPI Number Information
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NPI Number | 1679271324
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Entity Type | Organization
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Legal Business Name | DENTAL PROFESSIONALS OF WASHINGTON, QUIRT, MONGRAIN, GIBREE, PC
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Dates
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Enumeration Date | 02/22/2023
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 15514 MERIDIAN E
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City | PUYALLUP
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State | WA
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Zip | 98375-9513
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Country | US
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Telephone | 253-268-1215
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Fax | 253-268-1213
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Provider Business Mailing Address
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Address Line | 15514 MERIDIAN E
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City | PUYALLUP
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State | WA
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Zip | 98375-9513
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Country | US
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Telephone | 253-268-1215
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Fax | 253-268-1213
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | BELINDA HUERTA
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Credential |
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Telephone | 217-540-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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