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General NPI Number Information
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NPI Number | 1609173749
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Entity Type | Individual
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Provider Name | KATHRYN ASHLEY EDGCOMB D.D.S., M.S.
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Gender | Female
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 08/12/2011
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Provider Practice Location Address
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Address Line | 1376 REID FARM RD
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City | ROCKFORD
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State | IL
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Zip | 61107-2679
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Country | US
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Telephone | 815-494-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 1376 REID FARM RD
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City | ROCKFORD
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State | IL
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Zip | 61107-2679
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Country | US
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Telephone | 815-494-8884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019028542
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021002415
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License Number State | IL
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