Provider Demographics
NPI:1992428395
Name:QUIRT, MONGRAIN, GIBREE, P.C.
Entity type:Organization
Organization Name:QUIRT, MONGRAIN, GIBREE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIA TEAM
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:THULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8946
Mailing Address - Street 1:2222 MERIDIAN AVE E STE C
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98371-1032
Mailing Address - Country:US
Mailing Address - Phone:253-952-6112
Mailing Address - Fax:
Practice Address - Street 1:2222 MERIDIAN AVE E STE C
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98371-1032
Practice Address - Country:US
Practice Address - Phone:253-952-6112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUIRT, MONGRAIN, GIBREE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty