Provider Demographics
NPI:1629393962
Name:AFFORDABLE DENTISTRY TODAY
Entity Type:Organization
Organization Name:AFFORDABLE DENTISTRY TODAY
Other - Org Name:AFFORDABLE DENTISTRY TODAY - ROCKFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:5819 E RIVERSIDE BLVD # 21
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-4963
Mailing Address - Country:US
Mailing Address - Phone:815-282-4311
Mailing Address - Fax:815-282-4315
Practice Address - Street 1:5819 E RIVERSIDE BLVD # 21
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-4963
Practice Address - Country:US
Practice Address - Phone:815-282-4311
Practice Address - Fax:815-282-4315
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFORDABLE DENTISTRY TODAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty