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General NPI Number Information
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NPI Number | 1649955923
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Entity Type | Organization
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Legal Business Name | VIRDEN FAMILY DENTAL
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 155 N SPRINGFIELD ST
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City | VIRDEN
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State | IL
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Zip | 62690-1455
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Country | US
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Telephone | 217-965-5631
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Fax |
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Provider Business Mailing Address
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Address Line | 155 N SPRINGFIELD ST
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City | VIRDEN
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State | IL
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Zip | 62690-1455
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Country | US
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Telephone | 217-965-5631
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. ASHLEY NOWDOMSKI
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Credential | DMD
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Telephone | 708-897-7259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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