Dental Professionals of Washington Quirt Mongrain Gibree PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DENTAL PROFESSIONALS OF WASHINGTON QUIRT MONGRAIN GIBREE PC

Doing business as

Cedar Family Dentistry

Practice address

505 Cedar Ave Ste C1
Marysville, WA 98270-4561

Phone

(360) 659-3232

NPI assigned

Dec 19, 2019

Last updated

Apr 9, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

DENTAL PROFESSIONALS OF WASHINGTON, QUIRT, MONGRAIN, GIBREE, PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tabatha Lemke

Title

Credentialing Coordinator

Phone

(217) 540-6078

Specialties & licenses 1

Addresses

Other names 1

• Cedar Family Dentistry Doing business as

Part of

Dental Professionals of Washington Quirt Mongrain Gibree PC

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586390400000",
    "number": "1033757125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 CEDAR AVE STE C1",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982704561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 CEDAR AVE STE C1",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982704561",
            "telephone_number": "360-659-3232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF WASHINGTON QUIRT MONGRAIN GIBREE PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF WASHINGTON, QUIRT, MONGRAIN, GIBREE, PC",
        "enumeration_date": "2019-12-19",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A",
        "authorized_official_last_name": "LEMKE",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-6078"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cedar Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dirk T. De Young, DDS
• Danielle Dean, CD
• Grace Gretchen Delap
• Maria Teresa Dellino
• Dennis L. Booth. D.C., PLLC (Fourth Street Chiropractic)
• Benjamin Devaud
• Hector Diaz-Otero, MD
• Dirk T. de Young, D.D.S.
• Rebecca Lynn Dirks, N.D.
• Austin Taylor Dix

• General Practice Dentistry in Marysville, WA
• Providers in Marysville, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.