Organization
MICHAEL DEGOULD DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL DAVID DEGOULD DDS (ORAL SURGEON OWNER)
(815) 654-0039
Entity
Organization
Contact information
Practice address
2835 MCFARLAND ROAD, SUITE C, ROCKFORD, IL 61107
(815) 654-0039
(815) 654-0650
Mailing address
2835 MCFARLAND ROAD, SUITE C, ROCKFORD, IL 61107
(815) 654-0039
(815) 654-0650
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
021001500
IL
Other
Enumeration date
12/04/2006
Last updated
01/28/2013
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