Individual
HENRY HACKNEY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
845 S PERRYVILLE RD, ROCKFORD, IL 61108-4340
(773) 423-2135
Mailing address
845 S PERRYVILLE RD, ROCKFORD, IL 61108-4340
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.030806
IL
Other
Enumeration date
05/10/2016
Last updated
07/01/2016
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