# DENTAL PROFESSIONALS OF WASHINGTON QUIRT MONGRAIN GIBREE PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DENTAL PROFESSIONALS OF WASHINGTON, QUIRT, MONGRAIN, GIBREE, PC
- **Other names:** Cedar Family Dentistry
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1033757125
- **Legal business name:** DENTAL PROFESSIONALS OF WASHINGTON, QUIRT, MONGRAIN, GIBREE, PC
- **Authorized official:** TABATHA LEMKE (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-6078

## Contact information

- **Practice address:** 505 CEDAR AVE STE C1, MARYSVILLE, WA 98270-4561
- **Practice address phone:** (360) 659-3232
- **Mailing address:** 505 CEDAR AVE STE C1, MARYSVILLE, WA 98270-4561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/19/2019
- **Last updated:** 04/09/2020