205 Direct Dental Services INC.
Dentist in Rockford, IL. Organization (NPI-2).
NPI number1386525889
StatusActive
Last updated in NPPESSep 10, 2025
Details
- NPI
- 1386525889
- Entity type
- Organization (NPI-2)
- Legal business name
- 205 Direct Dental Services INC.
- Organization subpart
- No
- Enumeration date
- Sep 10, 2025
- Certification date
- Sep 10, 2025
- Last updated
- Sep 10, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | – | – | Yes |
Practice location
4151 Samuelson RdRockford, IL 61109-3272
Phone 815-637-6400
Mailing address
3957 N Mulford RdRockford, IL 61114-8004
Phone 815-637-6400 · Fax 815-637-6477
Authorized official
Henry Cyrus Oates
Dentist / President
8156376400
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