Provider Demographics
NPI:1851523146
Name:GREAT SMILES OF ROCKFORD
Entity Type:Organization
Organization Name:GREAT SMILES OF ROCKFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIERA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ABIERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:815-395-1600
Mailing Address - Street 1:780 N. MULFRORD ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107
Mailing Address - Country:US
Mailing Address - Phone:815-395-1600
Mailing Address - Fax:
Practice Address - Street 1:780 N. MULFRORD ROAD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107
Practice Address - Country:US
Practice Address - Phone:815-395-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment