Provider Demographics
NPI:1174699797
Name:GOOD DENTAL CARE
Entity type:Organization
Organization Name:GOOD DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-627-2914
Mailing Address - Street 1:RR #1 BOX 99
Mailing Address - Street 2:
Mailing Address - City:BIGGSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61418
Mailing Address - Country:US
Mailing Address - Phone:309-627-9200
Mailing Address - Fax:309-627-9202
Practice Address - Street 1:RR #1 BOX 99
Practice Address - Street 2:
Practice Address - City:BIGGSVILLE
Practice Address - State:IL
Practice Address - Zip Code:61418
Practice Address - Country:US
Practice Address - Phone:309-627-9200
Practice Address - Fax:309-627-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
126800000X
IL122300000X, 124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered126800000XDental ProvidersDental AssistantGroup - Single Specialty
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Single Specialty