Provider Demographics
NPI:1275353989
Name:TIMOTHY QUIRT, MONGRAIN, GIBREE, P.C.
Entity type:Organization
Organization Name:TIMOTHY QUIRT, MONGRAIN, GIBREE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CEMYIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-764-8609
Mailing Address - Street 1:623 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2101
Mailing Address - Country:US
Mailing Address - Phone:360-805-9060
Mailing Address - Fax:
Practice Address - Street 1:623 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2101
Practice Address - Country:US
Practice Address - Phone:360-805-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIMOTHY QUIRT, MONGRAIN, GIBREE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-16
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty