Provider Demographics
NPI:1225683766
Name:THE DENTAL GROUP OF GALESBURG PLLC
Entity Type:Organization
Organization Name:THE DENTAL GROUP OF GALESBURG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRECH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-556-4342
Mailing Address - Street 1:3393 MOENCKS RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5605
Mailing Address - Country:US
Mailing Address - Phone:270-556-4342
Mailing Address - Fax:
Practice Address - Street 1:1865 N HENDERSON ST STE 9
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1377
Practice Address - Country:US
Practice Address - Phone:270-556-4342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty