Rockford Family Dental P.c.

NPI #1386982940 in Rockford, Illinois

Provider Information

NPI Number: 1386982940
Entity Type: Organization
Organization Name: Rockford Family Dental P.c.
Primary Specialty: Dentist - General Practice
Enumeration Date: Jan 16, 2013
Last Updated: May 14, 2014

Practice Location

Address: 2715 N MAIN ST
City: Rockford
State: Illinois
ZIP Code: 61103-3111
Phone: (815) 964-8713

Authorized Official

Name: DR. RAZVAN CORNEL MIRZA, DDS
Title: SECRETARY/TREASURER
Phone: (815) 964-8713

Specialties & Taxonomy Codes

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

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