Provider Demographics
NPI:1093268344
Name:GALVA FAMILY DENTISTRY, INC
Entity Type:Organization
Organization Name:GALVA FAMILY DENTISTRY, INC
Other - Org Name:MORTON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BIALOBRESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-932-2000
Mailing Address - Street 1:217 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GALVA
Mailing Address - State:IL
Mailing Address - Zip Code:61434-1766
Mailing Address - Country:US
Mailing Address - Phone:309-932-2000
Mailing Address - Fax:
Practice Address - Street 1:313 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2027
Practice Address - Country:US
Practice Address - Phone:309-263-0821
Practice Address - Fax:309-263-0821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GALVA FAMILY DENTISTRY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty