Organization
PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY JAMES JOHNSON DDS (PEDIATRIC DENTIST OWNER PRESIDENT)
(815) 398-2323
Entity
Organization
Contact information
Practice address
4903 E STATE ST, ROCKFORD, IL 61108
(815) 398-2323
(815) 398-2328
Mailing address
4903 E STATE ST, ROCKFORD, IL 61108
(815) 398-2323
(815) 398-2328
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
019
IL
1223P0221X
Pediatric Dentistry
Primary
—
IL
Other
Enumeration date
08/27/2006
Last updated
08/22/2020
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