Healthcare Provider Details

I. General information

NPI: 1881808053
Provider Name (Legal Business Name): ORAL AND MAXILLOFACIAL SURGERY SPECALISTS LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4035 MORSAY DR.
ROCKFORD IL
61107-4871
US

IV. Provider business mailing address

4035 MORSAY DR.
ROCKFORD IL
61107-4871
US

V. Phone/Fax

Practice location:
  • Phone: 815-226-8920
  • Fax: 815-226-8928
Mailing address:
  • Phone: 815-226-8920
  • Fax: 815-226-8928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. DAVID A. FRANCIS
Title or Position: ORAL & MAXILLOFACIAL SURGEON
Credential: D.D.S.
Phone: 815-226-8920