Provider Demographics
NPI:1487410049
Name:NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.
Entity type:Organization
Organization Name:NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CEMYIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-764-8609
Mailing Address - Street 1:1121 STEAMBOAT PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-6429
Mailing Address - Country:US
Mailing Address - Phone:775-418-7990
Mailing Address - Fax:775-480-7992
Practice Address - Street 1:1121 STEAMBOAT PKWY STE 3
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-6429
Practice Address - Country:US
Practice Address - Phone:775-418-7990
Practice Address - Fax:775-480-7992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA DENTAL PROFESSIONAL, QUIRT, KRUYER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty