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General NPI Number Information
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NPI Number | 1942412390
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Entity Type | Organization
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Legal Business Name | SCHWALBE FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 05/05/2007
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 1807 WOODFIELD DR
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City | SAVOY
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State | IL
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Zip | 61874-9476
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Country | US
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Telephone | 217-351-9096
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Fax | 217-366-0147
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Provider Business Mailing Address
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Address Line | 1807 WOODFIELD DR
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City | SAVOY
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State | IL
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Zip | 61874-9476
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Country | US
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Telephone | 217-351-9096
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Fax | 217-366-0147
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THOMAS LEE SCHWALBE
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Credential | D.D.S.
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Telephone | 217-351-9096
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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 | 19014675
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License Number State | IL
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