Organization
PERIODONTICS OF ROCKFORD LTD.
Active
Parent organization
PERIODONTICS OF ROCKFORD LTD.
Organization subpart
Yes
Provider details
NPI number
Legal business name
PERIODONTICS OF ROCKFORD LTD.
Authorized official
JEFFREY V.A. BURCH D.M.D., M.S. (PERIODONTIST)
(815) 227-5858
Entity
Organization
Contact information
Practice address
1055 FEATHERSTONE RD, ROCKFORD, IL 61107
(815) 227-5858
(815) 227-6238
Mailing address
1055 FEATHERSTONE RD, ROCKFORD, IL 61107
(815) 227-5858
(815) 227-6238
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
021002217
IL
Other
Enumeration date
10/30/2008
Last updated
10/30/2008
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