Organization
MODERN DENTAL OF ROCKFORD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF THOMAS (PRESIDENT)
(618) 532-4902
Entity
Organization
Contact information
Practice address
1321 SANDY HOLLOW RD, ROCKFORD, IL 61109-2120
(815) 209-9070
Mailing address
1321 SANDY HOLLOW RD, ROCKFORD, IL 61109-2120
(815) 209-9070
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/02/2010
Last updated
03/02/2010
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