Great Smiles of Rockford, LTD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GREAT SMILES OF ROCKFORD, LTD

Practice address

780 N Mulford Rd
Rockford, IL 61107-3855

Phone

(815) 395-1600

Fax

(815) 399-0614

NPI assigned

Apr 19, 2007

Last updated

Sep 27, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jonathan Nabong Abiera, DMDNPI 1831347830

Title

President

Phone

(815) 395-1600

Specialties & licenses 1

Addresses

Tax ID family

Great Smiles of Rockford2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Great Smiles of Rockford

  • Customized Equipment (DME)
  • Rockford, IL
  • NPI 1851523146
  NPD tax ID

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.

• Jonathan Nabong Abiera, DMD

  • Dentist
  • Rockford, IL
  • NPI 1831347830
  NPD (past) Authorized official

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190851200000",
    "number": "1538386933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 N MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611073855",
            "telephone_number": "815-395-1600",
            "fax_number": "815-399-0614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 N MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611073855",
            "telephone_number": "815-395-1600",
            "fax_number": "815-399-0614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT SMILES OF ROCKFORD, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2007-09-27",
        "status": "A",
        "authorized_official_last_name": "ABIERA",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "NABONG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-395-1600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Leanne Gray, ATC
• Dale R Gray, M.D.
• Sarah Elizabeth Gray
• Great Lakes Neuropsychology & Counseling LLC
• Great Smiles of Rockford
• Christopher A Green, MD
• Christy Green, L.S.W.
• Daniel Robert Green, DNP, NP-C
• Gordon K Green, PT, OMT
• James Leitze Green, M.D.

• 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 Sep 27, 2007; 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.