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General NPI Number Information
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NPI Number | 1841461845
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Entity Type | Organization
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Legal Business Name | MILESTONE DENTAL CLINIC
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 275 NORTH PHELPS AVENUE
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City | ROCKFORD
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State | IL
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Zip | 61108-2434
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Country | US
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Telephone | 815-484-8678
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Fax | 815-484-8680
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Provider Business Mailing Address
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Address Line | 275 N PHELPS AVE
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City | ROCKFORD
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State | IL
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Zip | 61108-2434
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Country | US
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Telephone | 815-484-8678
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Fax | 815-484-8680
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. WILLIAM C. GRAHN
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Credential |
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Telephone | 815-639-2817
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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 |
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License Number State |
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