Organization
32DRS FAMILY DENTAL 2, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB PHILIP (OWNER)
(847) 250-7784
Entity
Organization
Contact information
Practice address
5876 E STATE ST, ROCKFORD, IL 61108-2428
(847) 250-7784
Mailing address
5876 E STATE ST, ROCKFORD, IL 61108-2428
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/07/2022
Last updated
09/07/2022
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