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General NPI Number Information
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NPI Number | 1295192144
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Entity Type | Organization
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Legal Business Name | WOOLERY DENTAL P.C.
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Dates
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Enumeration Date | 01/23/2016
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 5301 E STATE ST STE 306
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City | ROCKFORD
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State | IL
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Zip | 61108-2390
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Country | US
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Telephone | 815-399-2542
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Fax | 815-399-4716
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Provider Business Mailing Address
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Address Line | 5301 E STATE ST STE 306
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City | ROCKFORD
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State | IL
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Zip | 61108-2390
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Country | US
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Telephone | 815-399-2542
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Fax | 815-399-4716
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | JENNIFER K WOOLERY
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Credential | DMD
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Telephone | 815-399-2542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019026188
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License Number State | IL
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