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General NPI Number Information
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NPI Number | 1265954598
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Entity Type | Organization
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Legal Business Name | EAST MOLINE DENTAL CENTER PC
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 401 AVENUE OF THE CITIES
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City | EAST MOLINE
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State | IL
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Zip | 61244-4024
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Country | US
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Telephone | 309-755-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 401 AVENUE OF THE CITIES
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City | EAST MOLINE
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State | IL
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Zip | 61244-4024
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Country | US
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Telephone | 309-755-1700
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MICHAEL KENDALL
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Credential | D.M.D.
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Telephone | 309-755-1700
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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 | 060.012083
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License Number State | IL
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