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Individual

DR. JULIA R PESAVENTO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.M.D.

Contact information

Practice address
1075 FEATHERSTONE RD STE 30, ROCKFORD, IL 61107-5906
(815) 395-1711
(815) 395-1705
Mailing address
1075 FEATHERSTONE ROAD, SUITE 30, ROCKFORD, IL 61072
(815) 395-1711
(815) 395-1705

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-019656
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
$$$$$$$$$
SOCIAL SECURTIY NUMBER
IL
01
019-019656
LICENSE NUMBER
IL
Enumeration date
04/16/2007
Last updated
05/28/2020
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