# DENTAL PROFESSIONALS OF WASHINGTON QUIRT MONGRAIN GIBREE PC

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

## Provider details

- **NPI number:** 1174281679
- **Legal business name:** HEARTLAND DENTAL
- **Authorized official:** HILLARY THULL (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-8946

## Contact information

- **Practice address:** 8745 PACIFIC AVE NW STE 101, SILVERDALE, WA 98383-8394
- **Practice address phone:** (360) 692-9437
- **Mailing address:** 8745 PACIFIC AVE NW STE 101, SILVERDALE, WA 98383-8394

## Taxonomy

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

## Other

- **Enumeration date:** 12/01/2021
- **Last updated:** 12/01/2021