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General NPI Number Information
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NPI Number | 1891237285
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Entity Type | Organization
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Legal Business Name | ANTHONY F BENASSI DDS LLC
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 735 N PERRYVILLE RD SUITE 2
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City | ROCKFORD
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State | IL
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Zip | 61107-6236
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Country | US
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Telephone | 815-397-2752
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Fax | 815-397-2759
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Provider Business Mailing Address
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Address Line | 735 N PERRYVILLE RD SUITE 2
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City | ROCKFORD
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State | IL
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Zip | 61107-6236
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Country | US
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Telephone | 815-397-2752
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Fax | 815-397-2759
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. ANTHONY F BENASSI
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Credential | DDS
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Telephone | 815-397-2752
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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 | 19023203
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License Number State | IL
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