Healthcare Provider Details

I. General information

NPI: 1689792038
Provider Name (Legal Business Name): FEHR ORTHODONTICS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 ARCHER DR SUITE 200
EAST MOLINE IL
61244-3757
US

IV. Provider business mailing address

3800 ARCHER DR SUITE 200
EAST MOLINE IL
61244-3757
US

V. Phone/Fax

Practice location:
  • Phone: 309-751-3080
  • Fax:
Mailing address:
  • Phone: 309-751-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. DALE EDWARD FEHR
Title or Position: ORTHODONTIST
Credential: DDS,MS
Phone: 309-751-3080