Provider Demographics
NPI:1043687155
Name:DOROBA DENTAL INC
Entity type:Organization
Organization Name:DOROBA DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOROBA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:309-764-9099
Mailing Address - Street 1:518 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3760
Mailing Address - Country:US
Mailing Address - Phone:309-764-9099
Mailing Address - Fax:
Practice Address - Street 1:518 19TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3760
Practice Address - Country:US
Practice Address - Phone:309-764-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019936122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty