Razvan Cornel Mirza, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019026551 Issued in IL

Practice address

2715 N Main St
Rockford, IL 61103-3111

Phone

(815) 964-8713

Fax

(815) 964-3719

NPI assigned

Apr 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rockford Family Dental P.C.

  • General Practice Dentistry
  • Rockford, IL
  • NPI 1386982940
  NPD (past) Authorized official

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400025600000",
    "number": "1346202918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2715 N MAIN ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033111",
            "telephone_number": "815-964-8713",
            "fax_number": "815-964-8713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2715 N MAIN ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033111",
            "telephone_number": "815-964-8713",
            "fax_number": "815-964-3719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRZA",
        "first_name": "RAZVAN",
        "middle_name": "CORNEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2014-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9178466",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Francis Joseph Minor
• Kami Minor
• William Stephen Minore, M.D.
• Kristine Joy Mique
• Laura M Miranda, LMT
• Taha Mirza, DDS
• Stefania Teresa Missanelli, OTR
• David R. Mitchell, MD
• Jennifer Mitchell, LMFT
• Patricia Anne Mitchell, PMHNP

• General Practice Dentistry in Rockford, IL
• Providers in Rockford, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.