Provider Demographics
NPI:1386525889
Name:205 DIRECT DENTAL SERVICES INC.
Entity type:Organization
Organization Name:205 DIRECT DENTAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:CYRUS
Authorized Official - Last Name:OATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-637-6400
Mailing Address - Street 1:3957 N MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8004
Mailing Address - Country:US
Mailing Address - Phone:815-637-6400
Mailing Address - Fax:815-637-6477
Practice Address - Street 1:4151 SAMUELSON RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-3272
Practice Address - Country:US
Practice Address - Phone:815-637-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty