NPIMap

Organization Active NPI

Rock River Oral Surgery & Dental Implant Center LLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Rockford, IL
National Provider Identifier
1811379142
Registry record updated Jun 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
License
019030148 Issued in WI
Legal business name
ROCK RIVER ORAL SURGERY & DENTAL IMPLANT CENTER LLC
Practice address
973 Featherstone Rd
Suite 102
Rockford, IL 61107-5912
Phone
(815) 399-1234
Fax
(815) 399-2423
NPI assigned
Jun 23, 2015
Last updated
Jun 23, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2015

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

Authorized official

Name
Shea McCue, DDS
Title
Oral Surgeon/Owner
Phone
(815) 399-1234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X 019030148 WI Primary

Addresses

Primary practice location

973 Featherstone Rd
Suite 102
Rockford, IL 61107-5912

Mailing address

973 Featherstone Rd
Suite 102
Rockford, IL 61107-5912
Phone (815) 399-1234

National Provider Directory

National Provider Directory

Locations

973 Featherstone Rd
Ste 102
Rockford, IL 61107
Phone (815) 399-1234

NPI Registry JSON

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

{
    "created_epoch": "1435017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435017600000",
    "number": "1811379142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "973 FEATHERSTONE RD",
            "address_2": "SUITE 102",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075912",
            "telephone_number": "815-399-1234",
            "fax_number": "815-399-2423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "973 FEATHERSTONE RD",
            "address_2": "SUITE 102",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075912",
            "telephone_number": "815-399-1234",
            "fax_number": "815-399-2423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCK RIVER ORAL SURGERY & DENTAL IMPLANT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-23",
        "last_updated": "2015-06-23",
        "status": "A",
        "authorized_official_last_name": "MCCUE",
        "authorized_official_first_name": "SHEA",
        "authorized_official_title_or_position": "ORAL SURGEON/OWNER",
        "authorized_official_telephone_number": "815-399-1234",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "019030148",
            "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 Jun 23, 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.

Verify at the official NPI Registry.