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Organization
GRAND VIEW DENTAL ARTS, LLC
Active
Organization
GRAND VIEW DENTAL ARTS, LLC
Active
Other names
Borden Dental Arts
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES SEYMOUR BORDEN III DDS (OWNER)
(618) 656-4202
Entity
Organization
Contact information
Practice address
201 S MAIN ST, EDWARDSVILLE, IL 62025-1921
(618) 656-4202
(618) 656-6580
Mailing address
201 S MAIN ST, EDWARDSVILLE, IL 62025-1921
(618) 656-4202
(618) 656-6580
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019024683
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649322561
GENERAL DENTIST
IL
Enumeration date
07/13/2017
Last updated
07/21/2022
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