River Valley Oral and Maxillofacial Surgery Clinic LTD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

RIVER VALLEY ORAL AND MAXILLOFACIAL SURGERY CLINIC LTD

Practice address

930 16TH Ave
Moline, IL 61265

Phone

(309) 797-1770

Fax

(309) 797-1791

NPI assigned

Apr 3, 2007

Last updated

Sep 24, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bradley J Lutchka, DMD MDNPI 1780654202

Title

Oral Surgeon

Phone

(309) 797-1770

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bradley J Lutchka

  • Oral and Maxillofacial Surgery (Dentist)
  • Moline, IL
  • NPI 1780654202
  Medicare reassignment Care Compare group NPD Authorized official
• Craig James Thatcher

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Moline, IL
  • NPI 1013984541
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1235250200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 16TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "61265",
            "telephone_number": "309-797-1770",
            "fax_number": "309-797-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 16TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "61265",
            "telephone_number": "309-797-1770",
            "fax_number": "309-797-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER VALLEY ORAL AND MAXILLOFACIAL SURGERY CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A",
        "authorized_official_last_name": "LUTCHKA",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ORAL SURGEON",
        "authorized_official_telephone_number": "309-797-1770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald Dale Riggins, D.M.D.
• Lonnie L Rinell, DC
• Chloe Frances Rittenhouse
• Eric Ritterhoff, MD
• River Bend Christian Counseling Inc (River Bend Christian Counseling)
• Tristyn Rose Rivera, RD, LDN
• Michelle Rivers, L.AC
• Riverside Dentistry, LLC
• Wanda L Robb, OTRL
• Robert E. Blew

• Oral and Maxillofacial Surgery (Dentist) in Moline, IL
• Providers in Moline, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.