Lallas, June Upshaw
Lallas, June Upshaw is an individual health care provider with primary practice located at 1200 W State St , Rockford IL 61102-2112. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Lallas, June Upshaw can be contacted via phone (815) 490-1600.Contact Information
Primary practice address
1200 W State St
Rockford IL 61102-2112
Phone: (815) 490-1600
Fax: (815) 547-1595
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 019023799 | Illinois |
Profile Details
| NPI number | 1528041597 |
|---|---|
| LBN Legal business name | Lallas, June Upshaw |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 23rd, 2005 |
| Last updated | Jul 31st, 2015 - about 9 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528041597 | NPPES |
| Illinois | MEDICAID | 019023799 |
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