Provider Demographics
NPI:1013184217
Name:QUAD CITIES PERIODONTICS, LLC
Entity Type:Organization
Organization Name:QUAD CITIES PERIODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:FRANZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:563-344-4867
Mailing Address - Street 1:1800 E 54TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2852
Mailing Address - Country:US
Mailing Address - Phone:563-344-4867
Mailing Address - Fax:563-344-0215
Practice Address - Street 1:1800 E 54TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2852
Practice Address - Country:US
Practice Address - Phone:563-344-4867
Practice Address - Fax:563-344-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08258261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental