| Forest City Dental Pc | |
|
1855 Daimler Rd Rockford IL 61112-1063 | |
| (815) 397-7454 | |
| (815) 397-7555 |
| Full Name | Forest City Dental Pc |
|---|---|
| Speciality | Dentist |
| Location | 1855 Daimler Rd, Rockford, Illinois |
| Authorized Official Name and Position | James Randol Stovall (PRESIDENT) |
| Authorized Official Contact | 8153977454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Forest City Dental Pc 1855 Daimler Rd Rockford IL 61112-1063 Ph: (815) 397-7454 | Forest City Dental Pc 1855 Daimler Rd Rockford IL 61112-1063 Ph: (815) 397-7454 |
| NPI Number | 1457801755 |
|---|---|
| Provider Enumeration Date | 10/11/2016 |
| Last Update Date | 12/20/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457801755 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019026159 (Illinois) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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