Periodontics of Rockford Ltd.

NPI #1295988574 in Rockford, Illinois

Provider Information

NPI Number: 1295988574
Entity Type: Organization
Organization Name: Periodontics of Rockford Ltd.
Subpart: Yes (part of a larger organization)
Parent Organization: PERIODONTICS OF ROCKFORD LTD.
Primary Specialty: Dentist
Enumeration Date: Oct 30, 2008
Last Updated: Oct 30, 2008

Practice Location

Address: 1055 FEATHERSTONE RD
City: Rockford
State: Illinois
ZIP Code: 61107
Phone: (815) 227-5858

Authorized Official

Name: JEFFREY V.A. BURCH, D.M.D., M.S.
Title: PERIODONTIST
Phone: (815) 227-5858

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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