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General NPI Number Information
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NPI Number | 1851523146
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Entity Type | Organization
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Legal Business Name | GREAT SMILES OF ROCKFORD
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 780 N. MULFRORD ROAD
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City | ROCKFORD
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State | IL
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Zip | 61107
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Country | US
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Telephone | 815-395-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 780 N. MULFRORD ROAD
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City | ROCKFORD
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State | IL
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Zip | 61107
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Country | US
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Telephone | 815-395-1600
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ABIERA N ABIERA
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Credential | DMD
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Telephone | 815-395-1600
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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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