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

General Provider Information

NPI Number	:	1750942967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.

Provider Business Mailing Address
First Line	:	8925 W RUSSELL RD STE 160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8925 W RUSSELL RD STE 160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1220
Country	:	US
Telephone Number	:	702-432-2223
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	TABATHA LEMKE
Credential	:
Telephone Number	:	217-540-6078

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	08/21/2023

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