Healthcare Provider Details

I. General information

NPI: 1609152131
Provider Name (Legal Business Name): AMY C SENH DDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 17TH STREET
ROCK ISLAND IL
61201
US

IV. Provider business mailing address

2917 17TH STREET
ROCK ISLAND IL
61201
US

V. Phone/Fax

Practice location:
  • Phone: 309-788-6001
  • Fax:
Mailing address:
  • Phone: 309-788-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number019026488
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number060.010815
License Number StateIL

VIII. Authorized Official

Name: DR. AMY C SENH
Title or Position: DENTIST
Credential: D.D.S
Phone: 309-788-6001