# 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:** Chapel Hill Family Dentistry
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1821606724
- **Legal business name:** DENTAL PROFESSIONALS OF WASHINGTON QUIRT MONGRAIN GIBREE PC
- **Authorized official:** TABATHA LEMKE (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-6078

## Contact information

- **Practice address:** 9514 4TH ST NE UNIT 102, LAKE STEVENS, WA 98258-1937
- **Practice address phone:** (425) 334-4001
- **Mailing address:** 9514 4TH ST NE UNIT 102, LAKE STEVENS, WA 98258-1937
- **Mailing address phone:** (425) 334-4001

## Taxonomy

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

## Other

- **Enumeration date:** 07/16/2020
- **Last updated:** 07/16/2020