Provider Demographics
NPI:1609152131
Name:AMY C SENH DDS LTD
Entity type:Organization
Organization Name:AMY C SENH DDS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SENH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-788-6001
Mailing Address - Street 1:2917 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201
Mailing Address - Country:US
Mailing Address - Phone:309-788-6001
Mailing Address - Fax:
Practice Address - Street 1:2917 17TH STREET
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201
Practice Address - Country:US
Practice Address - Phone:309-788-6001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060.0108151223G0001X
IL019026488302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty