Healthcare Provider Details

I. General information

NPI: 1013929942
Provider Name (Legal Business Name): ROCKFORD DENTAL CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N ALPINE RD
ROCKFORD IL
61107-2262
US

IV. Provider business mailing address

1301 N ALPINE RD
ROCKFORD IL
61107-2262
US

V. Phone/Fax

Practice location:
  • Phone: 815-397-4280
  • Fax: 815-484-2436
Mailing address:
  • Phone: 815-397-4280
  • Fax: 815-484-2436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROL LIEBER
Title or Position: SENIOR COORDINATOR
Credential:
Phone: 815-397-4280