Quirt Family Dentistry, Sc

NPI #1235404732 in Wausau, Wisconsin

Provider Information

NPI Number: 1235404732
Entity Type: Organization
Organization Name: Quirt Family Dentistry, Sc
Subpart: Yes (part of a larger organization)
Parent Organization: QUIRT FAMILY DENTISTRY, SC
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 16, 2012
Last Updated: Mar 16, 2012

Practice Location

Address: 200 E BRIDGE ST
Address 2: SUITE 100
City: Wausau
State: Wisconsin
ZIP Code: 54403-3574
Phone: (715) 843-9800

Authorized Official

Name: KIM WILSON
Title: CREDENTIALING COORDINATOR
Phone: (217) 540-5170

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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