BRADLEY J LUTCHKA (NPI# 1780654202) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780654202 |
| Entity Type | Individual |
| Full Name | BRADLEY J LUTCHKA |
| Practice Address |
930 16th Ave Moline IL 61265 |
| Practice Telephone | 3097971770 |
| Practice Fax Number | 3097971791 |
| Mailing Telephone | 3097971770 |
| Mailing Fax Number | 3097971791 |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2020-09-24 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
IL | Dental Providers |
| Street Address |
930 16TH AVE |
| City | MOLINE |
| State | IL |
| Zip Code | 61265 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356311088 | Carleton Scott Hlady | Dentist | 930 16th Ave, Moline, IL 61265 | 2006-01-25 |
| 1235250200 | River Valley Oral and Maxillofacial Surgery Clinic Ltd | Dentist | 930 16th Ave, Moline, IL 61265 | 2007-04-03 |
| 1013984541 | Craig James Thatcher | Oral & Maxillofacial Surgery | 930 16th Ave, Moline, IL 61265 | 2006-03-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861035438 | Ora Orthopedics, PC | Orthopaedic Surgery | 510 Valley View Drive, Moline, IL 61265 | 2019-10-25 |
| 1598231698 | Secure Dental Vi | Dentist | 106 16th St, Unit #90, Moline, IL 61265 | 2018-10-17 |
| 1487152088 | Fjellheim P.c | Chiropractor | 1535 47th Avenue, Suite 5, Moline, IL 61265 | 2018-01-29 |
| 1326567199 | Elizabeth Ann Teichler | Respiratory Therapist, Registered | 4360 7th Street, Moline, IL 61265 | 2017-09-13 |
| 1497279913 | Caroline M Mather | Behavioral Analyst | 2430 6th Avenue, Moline, IL 61265 | 2017-07-26 |
| 1639625239 | Elizabeth Anderson | Nurse's Aide | 4319 26th Ave Apt 1, Moline, IL 61265 | 2016-09-01 |
| 1437604154 | Lindsey Bollaert | Nurse Practitioner | 1100 36th Ave, Moline, IL 61265 | 2016-08-23 |
| 1437541869 | Divvymed, LLC | Pharmacy | 4300 44th Ave, Moline, IL 61265 | 2015-02-23 |
| 1477955250 | Todd Stone | Nurse Practitioner | 1100 3th Avenue, Moline, IL 61265 | 2014-09-23 |
| 1588084479 | Familia Dental Moline LLC | Dentist | 1102 4th Ave, Moline, IL 61265 | 2014-04-18 |
| Find all providers in zip 61265 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164733762 | Sarah L Ade | Dentist | 7017 John Deere Parkway - Suite 2b, Moline, IL 61265 | 2010-06-29 |
| 1356311088 | Carleton Scott Hlady | Dentist | 930 16th Ave, Moline, IL 61265 | 2006-01-25 |
| 1235250200 | River Valley Oral and Maxillofacial Surgery Clinic Ltd | Dentist | 930 16th Ave, Moline, IL 61265 | 2007-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255986576 | Othman Rezki | Dentist | 1900 W Polk St # 611, Chicago, IL 60612-3723 | 2019-08-04 |
| 1215410584 | David Peterson | Dentist | 1619 Brandywine Ln, Dixon, IL 61021-8757 | 2018-09-12 |
| 1952887374 | Winnebago Braces, LLC. | Dentist | 555 N Court St Ste 110, Rockford, IL 61103-6898 | 2018-07-18 |
| 1093232951 | Robert C. Bosack, Dds & Associates, Ltd | Dentist | 16011 108th Ave Ste A, Orland Park, IL 60467-8787 | 2017-08-23 |
| 1790146132 | Family Millennium Dentistry, Inc. | Dentist | 1342 W Randolph St, Chicago, IL 60607-1522 | 2016-03-13 |
| 1770962375 | Eunsu Jung | Dentist | 1902 N Prospect Ave Ste 1, Champaign, IL 61822-1411 | 2015-05-28 |
| 1811374945 | Alexandria Hawkins | Dentist | 6050 Brynwood Dr Ste 102, Rockford, IL 61114-6579 | 2015-04-27 |
| 1043607872 | Alissa Nicole Pullos | Dentist | 105 E 1st St Ste 103, Hinsdale, IL 60521 | 2015-04-20 |
| 1538592654 | Matthew Seena Hamedani | Dentist | 3116 Oak Park Ave, Berwyn, IL 60402 | 2013-08-13 |
| 1578907689 | M Timothy Murphy | Dentist | 500 Davis St Ste 509, Evanston, IL 60201-4621 | 2013-04-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.