Organization
PUMILIA FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PACITA MARIE PUMILIA DDS, DIPLOMATE ABDSM (DENTIST)
(815) 398-2410
Entity
Organization
Contact information
Practice address
755 S MULFORD RD, ROCKFORD, IL 61108-4208
(815) 398-2410
(815) 398-2620
Mailing address
755 S MULFORD RD, ROCKFORD, IL 61108-4208
(815) 398-2410
(815) 398-2620
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
319.010939
IL
332BC3200X
Customized Equipment (DME)
Primary
019021788
IL
Other
Enumeration date
10/22/2014
Last updated
01/22/2018
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