Provider Demographics
NPI:1447388913
Name:QUAD CITIESDENTAL HEALTH ASSOCIATES PLC
Entity Type:Organization
Organization Name:QUAD CITIESDENTAL HEALTH ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALPEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-359-7596
Mailing Address - Street 1:3432 JERSEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2298
Mailing Address - Country:US
Mailing Address - Phone:563-359-7596
Mailing Address - Fax:
Practice Address - Street 1:3432 JERSEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2298
Practice Address - Country:US
Practice Address - Phone:563-359-7596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2048157Medicaid