|
| |
|
1102 4th Ave. Moline IL 61265-1231 | |
| (309) 517-6217 | |
| (309) 517-6219 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1102 4th Ave., Moline, Illinois |
| Authorized Official Name and Position | Brandon Alexander Taylor (CREDENTIALING & PAYER RELATIONS MAN) |
| Authorized Official Contact | 8474537396 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2050 East Algonquin Road Suite 610 Schaumburg IL 60173-4166 Ph: (847) 453-7396 | 1102 4th Ave. Moline IL 61265-1231 Ph: (309) 517-6217 |
| NPI Number | 1588084479 |
|---|---|
| Provider Enumeration Date | 04/18/2014 |
| Last Update Date | 06/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588084479 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Doroba Dental Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 518 19th Ave, Moline, IL 61265 Phone: 309-764-9099 | |
Parkway View Family Dentistry Ltd Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 7017 John Deere Pkwy Ste 2b, Moline, IL 61265 Phone: 309-792-0513 Fax: 309-792-0534 | |
Robert E. Blew Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 604 35th Ave, Moline, IL 61265 Phone: 309-797-4336 | |
River Valley Oral And Maxillofacial Surgery Clinic Ltd Dental Clinic Medicare: Medicare Enrolled Practice Location: 930 16th Ave, Moline, IL 61265 Phone: 309-797-1770 Fax: 309-797-1791 | |
Riverside Dentistry, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 609 22nd St, Moline, IL 61265 Phone: 309-797-2001 Fax: 309-764-8236 |