Provider Demographics
NPI:1982069209
Name:GALVA FAMILY DENTISTRY, INC.
Entity Type:Organization
Organization Name:GALVA FAMILY DENTISTRY, INC.
Other - Org Name:ALEDO 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:309-932-8904
Practice Address - Street 1:403 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-1209
Practice Address - Country:US
Practice Address - Phone:309-582-2022
Practice Address - Fax:309-582-2022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GALVA FAMILY DENTISTRY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190278971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty