Provider Demographics
NPI:1295077394
Name:GOEBEL FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:GOEBEL FAMILY DENTISTRY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GOEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-277-3480
Mailing Address - Street 1:1601 RIVER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-1494
Mailing Address - Country:US
Mailing Address - Phone:309-277-3480
Mailing Address - Fax:309-277-3499
Practice Address - Street 1:1601 RIVER DR
Practice Address - Street 2:SUITE 300
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-1494
Practice Address - Country:US
Practice Address - Phone:309-277-3480
Practice Address - Fax:309-277-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190182181223G0001X
IL0190292571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty