Provider Demographics
NPI:1235960055
Name:NEVADA DENTAL PROFESSIONAL, QUIRT, GATES, PC
Entity type:Organization
Organization Name:NEVADA DENTAL PROFESSIONAL, QUIRT, GATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:THULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8946
Mailing Address - Street 1:1950 W CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1950 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0316
Practice Address - Country:US
Practice Address - Phone:725-316-5980
Practice Address - Fax:725-316-5981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA DENTAL PROFESSIONAL, QUIRT, GATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty