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General NPI Number Information
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NPI Number | 1205905312
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Entity Type | Organization
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Legal Business Name | CAMELOT ENDODONTICS LTD
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 2835 MCFARLAND RD STE B
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City | ROCKFORD
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State | IL
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Zip | 61107-6819
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Country | US
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Telephone | 815-636-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 2835 MCFARLAND RD STE B
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City | ROCKFORD
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State | IL
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Zip | 61107-6819
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ENDODONTIST
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Name | DR. GREGORY J PARSONS
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Credential |
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Telephone | 815-636-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State | IL
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