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MONGRAIN, GIBREE, QUIRT, PC

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Company Details

Legal Name: MONGRAIN, GIBREE, QUIRT, PC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: November 9th 2020
Expiration date: 30 Nov 2025
UBI Number: 604 672 134
Home State: ILLINOIS
Principal Office Street Address: Google Maps Logo 1200 NETWORK CENTRE DR, EFFINGHAM, IL, 62401-4602, UNITED STATES

Contact Details

E-Mail: CFOX@KCPAG.COM
Phone Number: +1 217-540-5100

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role
CORPORATION SERVICE COMPANY Registered Agent

Key Officers & Management

Name Role Address
TIMOTHY QUIRT Governing Person -
SETH GIBREE Governing Person -
ROBERT MONGRAIN Governing Person -
ROBERT MONGRAIN Incorporator 9441 S 78TH EAST AVE, TULSA, OK, 74133, UNITED STATES
SETH GIBREE Incorporator 2620 MONET DR, CUMMING, GA, 30041-7155, UNITED STATES
TIMOTHY QUIRT, DDS Incorporator 222450 BLUEBELL LN, WAUSAU, WI, 54401-6670, UNITED STATES

National Provider Identifier

NPI Number:
1215539200
Certification Date:
2020-11-11

Authorized Person:

Name:
TABATHA LEMKE
Role:
CREDENTIALING COORDINATOR
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

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