| Lj Dentistry Llc | |
|
2900 41st St Moline IL 61265-7823 | |
| (309) 764-3242 | |
| (309) 764-3267 |
| Full Name | Lj Dentistry Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2900 41st St, Moline, Illinois |
| Authorized Official Name and Position | Joseph D Jackson (OWNER/DENTIST) |
| Authorized Official Contact | 3097643242 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lj Dentistry Llc 2900 41st St Moline IL 61265-7823 Ph: (309) 764-3242 | Lj Dentistry Llc 2900 41st St Moline IL 61265-7823 Ph: (309) 764-3242 |
| NPI Number | 1760753362 |
|---|---|
| Provider Enumeration Date | 01/13/2012 |
| Last Update Date | 01/13/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760753362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 19026468 (Illinois) | Primary |
| 1223G0001X | Dentist - General Practice | 19015383 (Illinois) | Secondary |
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