# DENTAL PROFESSIONALS OF WASHINGTON QUIRT MONGRAIN GIBREE PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** HEARTLAND DENTAL
- **Other names:** Longston Place Dental
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1134865736
- **Legal business name:** HEARTLAND DENTAL
- **Authorized official:** HILLARY THULL (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-8946

## Contact information

- **Practice address:** 13333 MERIDIAN E STE E, PUYALLUP, WA 98373-2405
- **Practice address phone:** (253) 770-4342
- **Mailing address:** 13333 MERIDIAN E STE E, PUYALLUP, WA 98373-2405

## Taxonomy

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

## Other

- **Enumeration date:** 05/07/2022
- **Last updated:** 05/07/2022