| 205 Direct Dental Services Inc. | |
|
4151 Samuelson Rd Rockford IL 61109-3272 | |
| (815) 637-6400 | |
| Not Available |
| Full Name | 205 Direct Dental Services Inc. |
|---|---|
| Speciality | Dentist |
| Location | 4151 Samuelson Rd, Rockford, Illinois |
| Authorized Official Name and Position | Henry Cyrus Oates (DENTIST / PRESIDENT) |
| Authorized Official Contact | 8156376400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 205 Direct Dental Services Inc. 3957 N Mulford Rd Rockford IL 61114-8004 Ph: (815) 637-6400 | 205 Direct Dental Services Inc. 4151 Samuelson Rd Rockford IL 61109-3272 Ph: (815) 637-6400 |
| NPI Number | 1386525889 |
|---|---|
| Provider Enumeration Date | 09/10/2025 |
| Last Update Date | 09/10/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386525889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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