NPIMap

Organization Active NPI

Milestone Dental Clinic

  • General Practice Dentistry
  • Rockford, IL
National Provider Identifier
1841461845
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MILESTONE DENTAL CLINIC
Practice address
275 North Phelps Avenue
Rockford, IL 61108-2434
Phone
(815) 484-8678
Fax
(815) 484-8680
NPI assigned
Mar 18, 2008
Last updated
Sep 4, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MILESTONE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Authorized official

Name
Mr. William C. Grahn
Title
President & Ceo
Phone
(815) 639-2817

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

275 North Phelps Avenue
Rockford, IL 61108-2434

Mailing address

275 N Phelps Ave
Rockford, IL 61108-2434
Phone (815) 484-8678

Other identifiers 1

IdentifierTypeStateIssuer
102303MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Milestone Dental Clinic8 organizations share this tax ID, including this one
Part of
Milestone Dental Clinic

Other organizations with this tax ID 7

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

Locations

275 N Phelps Ave
Rockford, IL 61108
Phone (815) 484-8678

Practitioners & affiliated clinicians

Practitioners 2

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": "1205798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756944000000",
    "number": "1841461845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 N PHELPS AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082434",
            "telephone_number": "815-484-8678",
            "fax_number": "815-484-8680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 NORTH PHELPS AVENUE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082434",
            "telephone_number": "815-484-8678",
            "fax_number": "815-484-8680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILESTONE DENTAL CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILESTONE, INC.",
        "enumeration_date": "2008-03-18",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A",
        "authorized_official_last_name": "GRAHN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "815-639-2817",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102303",
            "state": "IL"
        }
    ],
    "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 Sep 4, 2025; 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.