| River Valley Oral And Maxillofacial Surgery Clinic Ltd | |
|
930 16th Ave Moline IL 61265 | |
| (309) 797-1770 | |
| (309) 797-1791 |
| Full Name | River Valley Oral And Maxillofacial Surgery Clinic Ltd |
|---|---|
| Speciality | Dentist |
| Location | 930 16th Ave, Moline, Illinois |
| Authorized Official Name and Position | Bradley J Lutchka (ORAL SURGEON) |
| Authorized Official Contact | 3097971770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| River Valley Oral And Maxillofacial Surgery Clinic Ltd 930 16th Ave Moline IL 61265 Ph: (309) 797-1770 | River Valley Oral And Maxillofacial Surgery Clinic Ltd 930 16th Ave Moline IL 61265 Ph: (309) 797-1770 |
| NPI Number | 1235250200 |
|---|---|
| Provider Enumeration Date | 04/03/2007 |
| Last Update Date | 09/24/2020 |
| Medicare PECOS PAC ID | 0143310466 |
|---|---|
| Medicare Enrollment ID | O20071226000182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235250200 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Bradley J Lutchka |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1780654202 PECOS PAC ID: 6406946722 Enrollment ID: I20071226000190 |
| Provider Name | Craig J Thatcher |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1013984541 PECOS PAC ID: 7315037637 Enrollment ID: I20071226000203 |
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