Provider Demographics
NPI:1508086943
Name:VERSLUIS, CHAD JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:JOSEPH
Last Name:VERSLUIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-1747
Mailing Address - Country:US
Mailing Address - Phone:309-757-9180
Mailing Address - Fax:309-757-9181
Practice Address - Street 1:3422 RIVER DR
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-1747
Practice Address - Country:US
Practice Address - Phone:309-757-9180
Practice Address - Fax:309-757-9181
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0271211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice