Provider Demographics
NPI:1699912386
Name:DENTAL DESIGNERS LLC
Entity type:Organization
Organization Name:DENTAL DESIGNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-398-3800
Mailing Address - Street 1:7474 E STATE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2644
Mailing Address - Country:US
Mailing Address - Phone:815-398-3800
Mailing Address - Fax:
Practice Address - Street 1:7474 E STATE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2644
Practice Address - Country:US
Practice Address - Phone:815-398-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190196031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty