NPIMap

Organization Active NPI

Mys-Roscoe LLC

  • Dental Clinic/Center
  • Roscoe, IL
National Provider Identifier
1073340766
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
MYS-ROSCOE LLC
Practice address
5416 Reimer Drive
Roscoe, IL 61073
Phone
(815) 398-3879
NPI assigned
Sep 17, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Todd SternNPI 1225257421
Title
Owner
Phone
(815) 398-3879

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

5416 Reimer Drive
Roscoe, IL 61073

Mailing address

1110 S Mulford Rd
Rockford, IL 61108-4213
Phone (815) 988-1993

Other names 1

  • maintain your smile Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726531200000",
    "number": "1073340766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 S MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611084213",
            "telephone_number": "815-988-1993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5416 REIMER DRIVE",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "61073",
            "telephone_number": "815-398-3879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYS-ROSCOE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-17",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-398-3879"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "maintain your smile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roscoe, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.