PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS LTD NPI 1376651679

NPI Information

PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS LTD is a pediatric dentistry dentist in Rockford, IL. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS LTD NPI is 1376651679. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

4903 E STATE ST
ROCKFORD, IL
ZIP 61108
Phone: (815) 398-2323
Fax: (815) 398-2328

The provider's authorized official is Jeffrey James Johnson .
The authorized official title is Pediatric Dentist Owner President and has the following contact phone number (815) 398-2323.

The enumeration date for this NPI number is 8/27/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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