| Kelly J. Moore D.d.s., P.c. | |
|
6075 Vantage Pl Rockford IL 61107-5905 | |
| (815) 399-9040 | |
| (815) 399-9336 |
| Full Name | Kelly J. Moore D.d.s., P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6075 Vantage Pl, Rockford, Illinois |
| Authorized Official Name and Position | Kelly James Moore (DENTIST/OWNER) |
| Authorized Official Contact | 8153999040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly J. Moore D.d.s., P.c. 6075 Vantage Pl Rockford IL 61107-5905 Ph: (815) 399-9040 | Kelly J. Moore D.d.s., P.c. 6075 Vantage Pl Rockford IL 61107-5905 Ph: (815) 399-9040 |
| NPI Number | 1891897799 |
|---|---|
| Provider Enumeration Date | 09/01/2006 |
| Last Update Date | 10/10/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891897799 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 060-003341 (Illinois) | Primary |
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