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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