MEDICARE: DENTAL DESIGNERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019019603	IL

General Provider Information

NPI Number	:	1699912386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL DESIGNERS LLC

Provider Business Mailing Address
First Line	:	7474 E STATE ST
Second Line	:	SUITE 110
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2644
Country	:	US
Telephone Number	:	815-398-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	7474 E STATE ST
Second Line	:	SUITE 110
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2644
Country	:	US
Telephone Number	:	815-398-3800
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DUANE D HANSEN
Credential	:
Telephone Number	:	815-398-3800

Provider Enumeration Date	:	01/16/2009
Last Update Date	:	01/16/2009

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