MEDICARE: NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry
2	1223G0001X	General Practice Dentistry	3496	NV

General Provider Information

NPI Number	:	1255576229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.

Provider Business Mailing Address
First Line	:	2560 MONTESSOURI
Second Line	:	ST #109
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3063
Country	:	US
Telephone Number	:	702-822-1008
Fax Number	:	702-822-1016

Provider Business Practice Location Address
First Line	:	2560 MONTESSOURI
Second Line	:	ST #109
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3063
Country	:	US
Telephone Number	:	702-822-1008
Fax Number	:	702-822-1016

Authorized Official
Title or Position	:	CRED SUP
Name	:	KIM ZUBER
Credential	:
Telephone Number	:	217-540-5170

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	09/26/2022

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