NPIMap

Organization Active NPI

Quirt, Mongrain, Gibree Professional Services, PC

  • Periodontics
  • Marysville, WA
National Provider Identifier
1215674163
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
QUIRT, MONGRAIN, GIBREE PROFESSIONAL SERVICES, PC
Practice address
5100 Grove St Ste a
Marysville, WA 98270-4492
Phone
(360) 659-6732
NPI assigned
May 12, 2022
Organization subpart
Yes
Parent organization
QUIRT, MONGRAIN, GIBREE PROFESSIONAL SERVICES, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

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

Authorized official

Name
Courtney R Monteith
Title
Credentialing Coordinator
Phone
(217) 540-8306

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

5100 Grove St Ste a
Marysville, WA 98270-4492

Mailing address

5100 Grove St Ste a
Marysville, WA 98270-4492

Other names 1

  • Marysville Periodontal and Implant Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Quirt Mongrain Gibree PC5 organizations share this tax ID, including this one
Part of
Quirt Mongrain Gibree Professional Services PC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5100 Grove St
Ste A
Marysville, WA 98270
Phone (360) 659-6732

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1652313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654214400000",
    "number": "1215674163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 GROVE ST STE A",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982704492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 GROVE ST STE A",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982704492",
            "telephone_number": "360-659-6732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUIRT, MONGRAIN, GIBREE PROFESSIONAL SERVICES, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "QUIRT, MONGRAIN, GIBREE PROFESSIONAL SERVICES, PC",
        "enumeration_date": "2022-05-12",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A",
        "authorized_official_last_name": "MONTEITH",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8306"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marysville Periodontal and Implant Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Marysville Periodontal and Implant Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marysville, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; 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.