NPIMap

Organization Active NPI

East Moline Dental Center PC

  • General Practice Dentistry
  • Colona, IL
National Provider Identifier
1376014746
Registry record updated Dec 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
EAST MOLINE DENTAL CENTER PC
Practice address
748 Green Park Ave
Colona, IL 61241-9617
Phone
(309) 792-2211
Fax
(309) 792-4678
NPI assigned
Dec 11, 2018
Organization subpart
Yes
Parent organization
EAST MOLINE DENTAL CENTER PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 11, 2018

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

Authorized official

Name
Michael A Kendall
Title
Dentist
Phone
(309) 755-1700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

748 Green Park Ave
Colona, IL 61241-9617

Mailing address

748 Green Park Ave
Colona, IL 61241-9617
Phone (309) 792-2211

Other names 1

  • Colona Dental Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
East Moline Dental Center PC2 organizations share this tax ID, including this one
Part of
East Moline Dental Center PC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

748 Green Park Ave
Colona, IL 61241
Phone (309) 792-2211

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1544486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544486400000",
    "number": "1376014746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "748 GREEN PARK AVE",
            "city": "COLONA",
            "state": "IL",
            "postal_code": "612419617",
            "telephone_number": "309-792-2211",
            "fax_number": "309-792-4678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "748 GREEN PARK AVE",
            "city": "COLONA",
            "state": "IL",
            "postal_code": "612419617",
            "telephone_number": "309-792-2211",
            "fax_number": "309-792-4678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST MOLINE DENTAL CENTER PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST MOLINE DENTAL CENTER PC",
        "enumeration_date": "2018-12-11",
        "last_updated": "2018-12-11",
        "status": "A",
        "authorized_official_last_name": "KENDALL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "309-755-1700"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colona Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colona, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.