Provider Demographics
NPI:1942412390
Name:SCHWALBE FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:SCHWALBE FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHWALBE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:217-351-9096
Mailing Address - Street 1:1807 WOODFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9476
Mailing Address - Country:US
Mailing Address - Phone:217-351-9096
Mailing Address - Fax:217-366-0147
Practice Address - Street 1:1807 WOODFIELD DR
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9476
Practice Address - Country:US
Practice Address - Phone:217-351-9096
Practice Address - Fax:217-366-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19014675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL19014675OtherLICENSE