# 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:** Church Creek Dental Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1851023352
- **Legal business name:** DENTAL PROFESSIONALS OF WASHINGTON, QUIRT, MONGRAIN, GIBREE, PC
- **Authorized official:** CELIA HAYES (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-2100

## Contact information

- **Practice address:** 26606 72ND AVE NW, STANWOOD, WA 98292-6203
- **Practice address phone:** (360) 926-0294
- **Practice address fax:** (360) 926-0692
- **Mailing address:** 26606 72ND AVE NW, STANWOOD, WA 98292-6203
- **Mailing address phone:** (360) 926-0294
- **Mailing address fax:** (360) 926-0692

## Taxonomy

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

## Other

- **Enumeration date:** 06/24/2022
- **Last updated:** 06/24/2022