# 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:** Wilderness Dental Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1518569086
- **Legal business name:** DENTAL PROFESSIONALS OF WASHINGTON, QUIRT, MONGRAIN, GIBREE, PC
- **Authorized official:** JESSICA BRITT (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-5100

## Contact information

- **Practice address:** 23818 225TH AVE SE STE 100, MAPLE VALLEY, WA 98038-5088
- **Practice address phone:** (425) 358-2553
- **Practice address fax:** (425) 358-7092
- **Mailing address:** 23818 225TH AVE SE STE 100, MAPLE VALLEY, WA 98038-5088
- **Mailing address phone:** (425) 358-2553

## Taxonomy

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

## Other

- **Enumeration date:** 11/10/2020
- **Last updated:** 01/15/2021