NPIMap

Organization Active NPI

Mys - Rockford LLC

  • Dental Clinic/Center
  • Rockford, IL
National Provider Identifier
1952771636
Registry record updated Jun 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
019024307 Issued in IL
Legal business name
MYS - ROCKFORD LLC
Practice address
1110 S Mulford Rd
Rockford, IL 61108-4213
Phone
(815) 398-3879
NPI assigned
Oct 6, 2015
Last updated
Jun 19, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2017

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

Authorized official

Name
Todd Stern, D.D.SNPI 1225257421
Title
Owner
Phone
(815) 398-2879

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 019021620 IL
Dental Clinic/Center 261QD0000X 019030473 IL
Dental Clinic/Center 261QD0000X 019024307 IL Primary
General Practice Dentistry 1223G0001X 019028820 IL

Addresses

Primary practice location

1110 S Mulford Rd
Rockford, IL 61108-4213

Mailing address

1110 S Mulford Rd
Rockford, IL 61108-4213
Phone (815) 398-3879

National Provider Directory

National Provider Directory

Locations

1110 S Mulford Rd
Rockford, IL 61108
Phone (815) 398-3879

Practitioners & affiliated clinicians

Practitioners 6

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": "1444089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497830400000",
    "number": "1952771636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 S MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611084213",
            "telephone_number": "815-398-3879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 S MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611084213",
            "telephone_number": "815-398-3879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYS - ROCKFORD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-06",
        "last_updated": "2017-06-19",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-398-2879",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019021620",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019030473",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019024307",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019028820",
            "primary": false
        }
    ],
    "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 19, 2017; 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.