Provider Demographics
NPI:1851836795
Name:GALVA FAMILY DENTISTRY, INC
Entity Type:Organization
Organization Name:GALVA FAMILY DENTISTRY, INC
Other - Org Name:RIVER CITY 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 1:2024 W ROHMANN AVE
Practice Address - Street 2:
Practice Address - City:WEST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-5500
Practice Address - Country:US
Practice Address - Phone:309-692-5863
Practice Address - Fax:309-692-3618
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GALVA FAMILY DENTISTRY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-02
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030989122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty