Active NPI
Gabrielle Chevance, D.M.D
- Dentist
- Rockford, IL
National Provider Identifier
1073988796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019030473
- Practice address
- 1110 S Mulford Rd
Rockford, IL 61108-4213 - Phone
- (815) 398-3879
- Fax
- (815) 398-1085
- NPI assigned
- Dec 7, 2015
- Last updated
- Dec 7, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019030473 | IL | Primary |
Addresses
Primary practice location
1110 S Mulford Rd
Rockford, IL 61108-4213
Mailing address
1110 S Mulford Rd
Rockford, IL 61108-4213
Phone (815) 398-3879
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019030473 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mys-Roscoe LLC | Past | Accepting new patients | |
| Mys - Rockford LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Rockford, IL
- NPI 1952771636
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1449446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449446400000",
"number": "1073988796",
"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": "815-398-3879",
"fax_number": "815-398-1085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 S MULFORD RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611084213",
"telephone_number": "815-398-3879",
"fax_number": "815-398-1085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHEVANCE",
"first_name": "GABRIELLE",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-07",
"last_updated": "2015-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019030473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.