# 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
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1609737733
- **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:** 420 N 56TH PL UNIT 150, RIDGEFIELD, WA 98642-3504
- **Practice address phone:** (564) 236-2950
- **Practice address fax:** (564) 236-2065
- **Mailing address:** 420 N 56TH PL UNIT 150, RIDGEFIELD, WA 98642-3504
- **Mailing address phone:** (564) 236-2950
- **Mailing address fax:** (564) 236-2065

## Taxonomy

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

## Other

- **Enumeration date:** 11/19/2025
- **Last updated:** 11/19/2025