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
Fax: (815) 547-1595
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528041597 NPPES
Illinois MEDICAID 019023799

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