Healthcare Provider Details

I. General information

NPI: 1750295390
Provider Name (Legal Business Name): ORTHODONTIC COUPLE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 MCFARLAND RD STE A
ROCKFORD IL
61107-6819
US

IV. Provider business mailing address

2835 MCFARLAND RD STE A
ROCKFORD IL
61107-6819
US

V. Phone/Fax

Practice location:
  • Phone: 815-636-2992
  • Fax:
Mailing address:
  • Phone: 815-636-2992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAJID HEIDARPOUR
Title or Position: PRESIDENT
Credential: DDS
Phone: 815-636-2992