# PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS LTD

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376651679
- **Authorized official:** DR. JEFFREY JAMES JOHNSON DDS (PEDIATRIC DENTIST OWNER PRESIDENT)
- **Authorized official phone:** (815) 398-2323

## Contact information

- **Practice address:** 4903 E STATE ST, ROCKFORD, IL 61108
- **Practice address phone:** (815) 398-2323
- **Practice address fax:** (815) 398-2328
- **Mailing address:** 4903 E STATE ST, ROCKFORD, IL 61108
- **Mailing address phone:** (815) 398-2323
- **Mailing address fax:** (815) 398-2328

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 019 | IL | — |
| 1223P0221X | Pediatric Dentistry | — | IL | Yes |

## Other

- **Enumeration date:** 08/27/2006
- **Last updated:** 08/22/2020