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General NPI Number Information
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NPI Number | 1750248514
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Entity Type | Organization
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Legal Business Name | EAST BELMONT DENTAL
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 228 E MAIN ST
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City | KNOXVILLE
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State | IL
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Zip | 61448-1351
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Country | US
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Telephone | 309-289-2570
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Fax |
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Provider Business Mailing Address
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Address Line | 228 E MAIN ST
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City | KNOXVILLE
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State | IL
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Zip | 61448-1351
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Country | US
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Telephone |
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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. EVERETT J BROKAW
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Credential | DMD
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Telephone | 719-293-3686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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