| Rockriver Dental Llc | |
|
318 College Ave Rockford IL 61104-2922 | |
| (815) 965-5555 | |
| (815) 965-5561 |
| Full Name | Rockriver Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 318 College Ave, Rockford, Illinois |
| Authorized Official Name and Position | Duane Hansen (SOLE MEMBER) |
| Authorized Official Contact | 8159655555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rockriver Dental Llc 318 College Ave Rockford IL 61104-2922 Ph: (815) 965-5555 | Rockriver Dental Llc 318 College Ave Rockford IL 61104-2922 Ph: (815) 965-5555 |
| NPI Number | 1336477769 |
|---|---|
| Provider Enumeration Date | 11/23/2009 |
| Last Update Date | 11/23/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336477769 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019019603 (Illinois) | Primary |
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