Provider Demographics
NPI:1609913524
Name:ALLIANCE DENTAL GROUP
Entity Type:Organization
Organization Name:ALLIANCE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:815-883-3162
Mailing Address - Street 1:210 N COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:OGLESBY
Mailing Address - State:IL
Mailing Address - Zip Code:61348-1480
Mailing Address - Country:US
Mailing Address - Phone:815-883-3162
Mailing Address - Fax:815-883-7062
Practice Address - Street 1:210 N COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:OGLESBY
Practice Address - State:IL
Practice Address - Zip Code:61348-1480
Practice Address - Country:US
Practice Address - Phone:815-883-3162
Practice Address - Fax:815-883-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty