| Rockford Modern Dental Llc | |
|
5909 E State St Rockford IL 61108-2429 | |
| (815) 904-8701 | |
| Not Available |
| Full Name | Rockford Modern Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5909 E State St, Rockford, Illinois |
| Authorized Official Name and Position | Jeff Thomas (PRESIDENT) |
| Authorized Official Contact | 6185324902 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rockford Modern Dental Llc 5909 E State St Rockford IL 61108-2429 Ph: (815) 904-8701 | Rockford Modern Dental Llc 5909 E State St Rockford IL 61108-2429 Ph: (815) 904-8701 |
| NPI Number | 1316260599 |
|---|---|
| Provider Enumeration Date | 03/02/2010 |
| Last Update Date | 03/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316260599 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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