# 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:** Family Dentistry on Lacey
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104566728
- **Legal business name:** DENTAL PROFESSIONALS OF WASHINGTON QUIRT MONGRAIN GIBREE PC
- **Authorized official:** HILLARY THULL (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-8946

## Contact information

- **Practice address:** 4445 LACEY BLVD SE, LACEY, WA 98503-5716
- **Practice address phone:** (360) 491-2532
- **Mailing address:** 4445 LACEY BLVD SE, LACEY, WA 98503-5716

## Taxonomy

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

## Other

- **Enumeration date:** 03/31/2022
- **Last updated:** 04/13/2022