| Pumilia Family Dental Llc | |
|
755 S Mulford Rd Rockford IL 61108-4208 | |
| (815) 398-2410 | |
| (815) 398-2620 |
| Full Name | Pumilia Family Dental Llc |
|---|---|
| Speciality | Durable Medical Equipment & Medical Supplies |
| Location | 755 S Mulford Rd, Rockford, Illinois |
| Authorized Official Name and Position | Pacita Marie Pumilia (DENTIST) |
| Authorized Official Contact | 8153982410 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pumilia Family Dental Llc 755 S Mulford Rd Rockford IL 61108-4208 Ph: (815) 398-2410 | Pumilia Family Dental Llc 755 S Mulford Rd Rockford IL 61108-4208 Ph: (815) 398-2410 |
| NPI Number | 1679977458 |
|---|---|
| Provider Enumeration Date | 10/22/2014 |
| Last Update Date | 01/22/2018 |
| Medicare PECOS PAC ID | 6901117704 |
|---|---|
| Medicare Enrollment ID | O20150619002318 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679977458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 319.010939 (Illinois) | Secondary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | 019021788 (Illinois) | Primary |
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