NPIMap

Organization Active NPI

Periodontics of Rockford LTD.

  • Dentist
  • Rockford, IL
National Provider Identifier
1295988574
Registry record updated Oct 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
021002217 Issued in IL
Legal business name
PERIODONTICS OF ROCKFORD LTD.
Practice address
1055 Featherstone Rd
Rockford, IL 61107
Phone
(815) 227-5858
Fax
(815) 227-6238
NPI assigned
Oct 30, 2008
Last updated
Oct 30, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
PERIODONTICS OF ROCKFORD LTD.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2008

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

Authorized official

Name
Jeffrey V.a. Burch, D.M.D., M.S.NPI 1285772483
Title
Periodontist
Phone
(815) 227-5858

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 021002217 IL Primary

Addresses

Primary practice location

1055 Featherstone Rd
Rockford, IL 61107

Mailing address

1055 Featherstone Rd
Rockford, IL 61107
Phone (815) 227-5858

National Provider Directory

National Provider Directory
Part of
Periodontics of Rockfor

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1225324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225324800000",
    "number": "1295988574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 FEATHERSTONE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61107",
            "telephone_number": "815-227-5858",
            "fax_number": "815-227-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 FEATHERSTONE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61107",
            "telephone_number": "815-227-5858",
            "fax_number": "815-227-6238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTICS OF ROCKFORD LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PERIODONTICS OF ROCKFORD LTD.",
        "enumeration_date": "2008-10-30",
        "last_updated": "2008-10-30",
        "status": "A",
        "authorized_official_last_name": "BURCH",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "V.A.",
        "authorized_official_title_or_position": "PERIODONTIST",
        "authorized_official_telephone_number": "815-227-5858",
        "authorized_official_credential": "D.M.D., M.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "021002217",
            "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 Oct 30, 2008; 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.