MEDICARE: ERIC SALUD DENTISTRY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1447196746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC SALUD DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	3020 CHARLES ST
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-1758
Country	:	US
Telephone Number	:	815-399-5181
Fax Number	:	815-399-1721

Provider Business Practice Location Address
First Line	:	3020 CHARLES ST
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-1758
Country	:	US
Telephone Number	:	815-399-5181
Fax Number	:	815-399-1721

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JOE SHIPPEE
Credential	:
Telephone Number	:	904-472-3839

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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