NPIMap

Organization Active NPI

Quirt, Mongrain, Gibree, P.C.

Doing business as Kenmore Dentistry

  • General Practice Dentistry
  • Kenmore, WA
National Provider Identifier
1336630615
Registry record updated Sep 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
QUIRT, MONGRAIN, GIBREE, P.C.
Doing business as
Kenmore Dentistry
Practice address
5723 NE Bothell Way Ste a
Kenmore, WA 98028-9404
Phone
(206) 525-2813
NPI assigned
May 23, 2018
Last updated
Sep 18, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF WASHINGTON QUIRT MONGRAIN GIBREE PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 18, 2020

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

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

5723 NE Bothell Way Ste a
Kenmore, WA 98028-9404

Mailing address

5723 NE Bothell Way Ste a
Kenmore, WA 98028-9404
Phone (206) 525-2813

Other names 1

  • Kenmore 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

5723 NE Bothell Way
Ste A
Kenmore, WA 98028
Phone (206) 525-2813

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600387200000",
    "number": "1336630615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5723 NE BOTHELL WAY STE A",
            "city": "KENMORE",
            "state": "WA",
            "postal_code": "980289404",
            "telephone_number": "206-525-2813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5723 NE BOTHELL WAY STE A",
            "city": "KENMORE",
            "state": "WA",
            "postal_code": "980289404",
            "telephone_number": "206-525-2813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUIRT, MONGRAIN, GIBREE, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF WASHINGTON QUIRT MONGRAIN GIBREE PC",
        "enumeration_date": "2018-05-23",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "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": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenmore Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kenmore, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.