NPIMap

Organization Active NPI

Dental Professionals of Washington Quirt Mongrain Gibree PC

Doing business as Canyon Creek Family & Implant Dentistry

  • Dentist
  • Everett, WA
National Provider Identifier
1255060109
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DENTAL PROFESSIONALS OF WASHINGTON QUIRT MONGRAIN GIBREE PC
Doing business as
Canyon Creek Family & Implant Dentistry
Practice address
4809 132ND St SE Ste A105
Everett, WA 98208-6241
Phone
(425) 585-0805
NPI assigned
Jun 7, 2022
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF WASHINGTON QUIRT MONGRAIN GIBREE PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

4809 132ND St SE Ste A105
Everett, WA 98208-6241

Mailing address

4809 132ND St SE Ste A105
Everett, WA 98208-6241

Other names 1

  • Canyon Creek Family & Implant Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of Washington Quirt Mongrain Gibree PC29 organizations share this tax ID, including this one
Part of
Dental Professionals of Washington Quirt Mongrain Gibree PC

Other organizations with this tax ID 28

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

View all 28

Locations

4809 132nd St SE
Ste A105
Everett, WA 98208
Phone (425) 585-0805

NPI Registry JSON

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1255060109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4809 132ND ST SE STE A105",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4809 132ND ST SE STE A105",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086241",
            "telephone_number": "425-585-0805"
        }
    ],
    "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": "2022-06-07",
        "last_updated": "2022-06-07",
        "certification_date": "2022-05-31",
        "status": "A",
        "authorized_official_last_name": "MONTEITH",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8306"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Creek Family & Implant Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.