Provider Demographics
NPI:1295192144
Name:WOOLERY DENTAL P.C.
Entity Type:Organization
Organization Name:WOOLERY DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOOLERY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:815-399-2542
Mailing Address - Street 1:5301 E STATE ST STE 306
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2390
Mailing Address - Country:US
Mailing Address - Phone:815-399-2542
Mailing Address - Fax:815-399-4716
Practice Address - Street 1:5301 E STATE ST STE 306
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2390
Practice Address - Country:US
Practice Address - Phone:815-399-2542
Practice Address - Fax:815-399-4716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-23
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190261881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty