Quirt Family Dentistry

NPI #1417414889 in Green Bay, Wisconsin

Provider Information

NPI Number: 1417414889
Entity Type: Organization
Organization Name: Quirt Family Dentistry
Subpart: Yes (part of a larger organization)
Parent Organization: QUIRT FAMILY DENTISTRY
Primary Specialty: Dentist - General Practice
Enumeration Date: Feb 21, 2019
Last Updated: Feb 21, 2019

Practice Location

Address: 709 S ONEIDA ST
City: Green Bay
State: Wisconsin
ZIP Code: 54304-2475
Phone: (920) 494-0554

Authorized Official

Name: TABATHA LEMKE
Title: CREDENTIALING COORDINATOR
Phone: (217) 540-6078

Specialties & Taxonomy Codes

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

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