Provider Demographics
NPI:1013570928
Name:ARCH VIEW FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:ARCH VIEW FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-335-0430
Mailing Address - Street 1:2133 S STATE ROUTE 157
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3691
Mailing Address - Country:US
Mailing Address - Phone:618-656-2006
Mailing Address - Fax:618-656-2066
Practice Address - Street 1:2133 S STATE ROUTE 157
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3691
Practice Address - Country:US
Practice Address - Phone:618-656-2006
Practice Address - Fax:618-656-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1720300585OtherNPI
IL19-028117OtherSTATE OF IL DENTAL LICENSE
IL1649495458OtherNPI
IL19-025636OtherSTATE OF IL DENTAL LICENSE