Park City Dental, Pc

NPI 1225469596 - Dentist - 122300000X

NPI Details
NPI 1225469596
Enumeration Date 12/11/2013
Last Updated 12/11/2013
Entity Type Healthcare Provider
Active Over 3 years ago
Authorized Information
Name JASON M JASON
Position PRESIDENT
Phone (815) 708-6556
Fax (815) 708-6477
Practice Location
555 N COURT ST
SUITE 100
ROCKFORD IL, 61103-6862, US
Phone (815) 708-6556
Fax (815) 708-6477
Business Location
555 N COURT ST
SUITE 100
ROCKFORD IL, 61103-6862, US
Phone (815) 708-6556
Fax (815) 708-6477
Toxanomy
Taxonomy Code 122300000X
License State Illinois
License Number 019026609
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According to our database, Park City Dental, Pc NPI is 1225469596, taxonomy code is 122300000X and license number is 019026609, license state is located at Illinois. Park City Dental, Pc physically located at 555 N Court St, Rockford IL, 61103-6862. NPI Number 1033115704 has the healthcare provider type.

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1225469596 NPI number is provided on an as is basis without warranty of any kind. 1225469596 is maintained by the National Plan & Provider Enumeration System. The contents of Park City Dental, Pc are for informational purposes only.