Organization
MYS - ROCKFORD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD STERN D.D.S (OWNER)
(815) 398-2879
Entity
Organization
Contact information
Practice address
1110 S MULFORD RD, ROCKFORD, IL 61108-4213
(815) 398-3879
Mailing address
1110 S MULFORD RD, ROCKFORD, IL 61108-4213
(815) 398-3879
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019028820
IL
261QD0000X
Dental Clinic/Center
019021620
IL
261QD0000X
Dental Clinic/Center
Primary
019024307
IL
261QD0000X
Dental Clinic/Center
019030473
IL
Other
Enumeration date
10/06/2015
Last updated
06/19/2017
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