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General NPI Number Information
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NPI Number | 1225683766
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Entity Type | Organization
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Legal Business Name | DENTAL GROUP OF GALESBURG PLLC
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 1865 N HENDERSON ST STE 9
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City | GALESBURG
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State | IL
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Zip | 61401-1377
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Country | US
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Telephone | 270-556-4342
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Fax |
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Provider Business Mailing Address
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Address Line | 1865 N HENDERSON ST STE 9
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City | GALESBURG
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State | IL
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Zip | 61401-1377
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Country | US
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Telephone | 309-342-4144
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. CODY KRECH
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Credential | DMD
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Telephone | 270-556-4342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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