Rockford Modern Dental LLC

NPI #1316260599 in Rockford, Illinois

Provider Information

NPI Number: 1316260599
Entity Type: Organization
Organization Name: Rockford Modern Dental LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 2, 2010
Last Updated: Mar 2, 2010

Practice Location

Address: 5909 E STATE ST
City: Rockford
State: Illinois
ZIP Code: 61108-2429
Phone: (815) 904-8701

Authorized Official

Name: MR. JEFF THOMAS
Title: PRESIDENT
Phone: (618) 532-4902

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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