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General NPI Number Information
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NPI Number | 1477975175
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Entity Type | Organization
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Legal Business Name | LONN E BRANDER DDS LTD
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 5668 E STATE ST SUITE 1100
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City | ROCKFORD
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State | IL
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Zip | 61108-2490
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Country | US
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Telephone | 815-977-5281
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Fax | 815-977-5361
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Provider Business Mailing Address
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Address Line | 5668 E STATE ST SUITE 1100
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City | ROCKFORD
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State | IL
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Zip | 61108-2490
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Country | US
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Telephone | 815-977-5281
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Fax | 815-977-5361
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Authorized Official
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Title or Position | OWNER
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Name | DR. LONN EDWARD BRANDER
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Credential | DDS
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Telephone | 815-756-2295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019-022322
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License Number State | IL
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