Organization
MONGRAIN, GIBREE, QUIRT, PC
Active
Parent organization
HEARTLAND DENTAL
Other names
Stanwood Advanced Family Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
HEARTLAND DENTAL
Authorized official
TABATHA LEMKE (CREDENTIALING COORDINATOR)
(217) 540-6078
Entity
Organization
Contact information
Practice address
9628 271ST ST NW, STANWOOD, WA 98292-8096
(360) 629-4597
Mailing address
9628 271ST ST NW, STANWOOD, WA 98292-8096
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/13/2020
Last updated
11/13/2020
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