Provider Demographics
NPI:1427675362
Name:QUIRT FAMILY DENTISTRY, S.C.
Entity type:Organization
Organization Name:QUIRT FAMILY DENTISTRY, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:N112W16286 MEQUON RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3306
Mailing Address - Country:US
Mailing Address - Phone:262-293-5034
Mailing Address - Fax:
Practice Address - Street 1:N112W16286 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3306
Practice Address - Country:US
Practice Address - Phone:262-293-5034
Practice Address - Fax:262-415-5277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUIRT FAMILY DENTISTRY, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-26
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty