Organization
HAWKEYE DENTAL CREATIONS
Active
Other names
Total Health Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELYN LEAH RICHARDSON DDS (PRESIDENT DENTIST)
(309) 762-3015
Entity
Organization
Contact information
Practice address
615 35TH AVENUE, MOLINE, IL 61265
(309) 762-3015
(309) 762-1461
Mailing address
615 35TH AVENUE, MOLINE, IL 61265
(309) 762-3015
(309) 762-1461
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019026572
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110282
—
IL
Enumeration date
02/23/2007
Last updated
06/25/2008
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