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Organization
ROCKRIVER DENTAL LLC
Active
Organization
ROCKRIVER DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUANE HANSEN D.D.S. (SOLE MEMBER)
(815) 965-5555
Entity
Organization
Contact information
Practice address
318 COLLEGE AVE, ROCKFORD, IL 61104-2922
(815) 965-5555
(815) 965-5561
Mailing address
318 COLLEGE AVE, ROCKFORD, IL 61104-2922
(815) 965-5555
(815) 965-5561
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019019603
IL
Other
Enumeration date
11/23/2009
Last updated
11/23/2009
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