Mirza, Razvan Cornel

Mirza, Razvan Cornel is an individual health care provider with primary practice located at 2715 N Main St , Rockford IL 61103-3111. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Mirza, Razvan Cornel can be contacted via phone (815) 964-8713.

Contact Information

Primary practice address
2715 N Main St Rockford IL 61103-3111
Phone: (815) 964-8713
Fax: (815) 964-3719
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 019026551 Illinois

Profile Details

NPI number 1346202918
LBN Legal business name Mirza, Razvan Cornel
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 6th, 2006
Last updated May 14th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346202918 NPPES
Illinois MEDICAID 9178466

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