# RIVER VALLEY ORAL AND MAXILLOFACIAL SURGERY CLINIC LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235250200
- **Authorized official:** DR. BRADLEY J LUTCHKA DMD MD (ORAL SURGEON)
- **Authorized official phone:** (309) 797-1770

## Contact information

- **Practice address:** 930 16TH AVE, MOLINE, IL 61265
- **Practice address phone:** (309) 797-1770
- **Practice address fax:** (309) 797-1791
- **Mailing address:** 930 16TH AVE, MOLINE, IL 61265
- **Mailing address phone:** (309) 797-1770
- **Mailing address fax:** (309) 797-1791

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 04/03/2007
- **Last updated:** 09/24/2020