Quirt Mongrain Gibree - Maryville, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

QUIRT MONGRAIN GIBREE - MARYVILLE, PC

Practice address

4445 Lacey Blvd SE
Lacey, WA 98503-5716

Phone

(360) 491-2532

NPI assigned

May 10, 2022

Organization subpart

Yes

Parent organization

QUIRT MONGRAIN GIBREE - MARYVILLE, PCAs reported in NPPES

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

Addresses

Other names 1

• Artesian Dental on Lacey Boulevard Doing business as

Part of

Quirt Mongrain Gibree - Maryville PC

Locations

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

{
    "created_epoch": "1652140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652140800000",
    "number": "1437895778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 LACEY BLVD SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035716",
            "telephone_number": "360-491-2532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 LACEY BLVD SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035716",
            "telephone_number": "360-491-2532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUIRT MONGRAIN GIBREE - MARYVILLE, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "QUIRT MONGRAIN GIBREE - MARYVILLE, PC",
        "enumeration_date": "2022-05-10",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "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": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Artesian Dental on Lacey Boulevard",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Donna Quach
• Qualified Surgical Services PLLC
• Riley Elizabeth Quezada, MS CCC-SLP
• Morgan Quigley
• Amber Christine Quinton, LMT
• Larisa G Raastad, M.D.
• Radiantcare Physicians, PLLC
• Thomas Frances Rafferty, MD
• David P Ragsdale, DDS
• Amanda Rainey, MA60114028

• General Practice Dentistry in Lacey, WA
• Providers in Lacey, 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 May 10, 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.