Forest City Dental PC

NPI #1457801755 in Rockford, Illinois

Provider Information

NPI Number: 1457801755
Entity Type: Organization
Organization Name: Forest City Dental PC
Primary Specialty: Dentist
Enumeration Date: Oct 11, 2016
Last Updated: Dec 20, 2016

Practice Location

Address: 1855 DAIMLER RD
City: Rockford
State: Illinois
ZIP Code: 61112-1063
Phone: (815) 397-7454

Authorized Official

Name: DR. JAMES RANDOL STOVALL, D.D.S.
Title: PRESIDENT
Phone: (815) 397-7454

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Durable Medical Equipment & Medical Supplies - Customized Equipment — Customized Equipment	332BC3200X
Dentist	122300000X	Primary

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