Rockriver Dental LLC

NPI #1336477769 in Rockford, Illinois

Provider Information

NPI Number: 1336477769
Entity Type: Organization
Organization Name: Rockriver Dental LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 23, 2009
Last Updated: Nov 23, 2009

Practice Location

Address: 318 COLLEGE AVE
City: Rockford
State: Illinois
ZIP Code: 61104-2922
Phone: (815) 965-5555

Authorized Official

Name: DR. DUANE HANSEN, D.D.S.
Title: SOLE MEMBER
Phone: (815) 965-5555

Specialties & Taxonomy Codes

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

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