# 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:** Dental Care at Brush Prairie
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1932813243
- **Legal business name:** DENTAL PROFESSIONALS OF WASHINGTON, QUIRT, MONGRAIN, GIBREE, PC
- **Authorized official:** BELINDA HUERTA (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-2100

## Contact information

- **Practice address:** 11610 NE 119TH ST, VANCOUVER, WA 98662-1616
- **Practice address phone:** (360) 597-7950
- **Practice address fax:** (360) 597-7991
- **Mailing address:** 11610 NE 119TH ST, VANCOUVER, WA 98662-1616
- **Mailing address phone:** (360) 597-7950
- **Mailing address fax:** (360) 597-7991

## Taxonomy

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

## Other

- **Enumeration date:** 01/11/2023
- **Last updated:** 01/11/2023