Provider Demographics
NPI:1205967940
Name:STRICTLY DENTURES, INC.
Entity type:Organization
Organization Name:STRICTLY DENTURES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-969-0531
Mailing Address - Street 1:615 N LONGWOOD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4265
Mailing Address - Country:US
Mailing Address - Phone:815-969-0531
Mailing Address - Fax:815-986-0486
Practice Address - Street 1:615 N LONGWOOD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4265
Practice Address - Country:US
Practice Address - Phone:815-969-0531
Practice Address - Fax:815-986-0486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty