NPIMap

Organization Active NPI

Ginger Creek Dental LLC

  • General Practice Dentistry
  • Glen Carbon, IL
National Provider Identifier
1023323623
Registry record updated Aug 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019025281 Issued in IL
Legal business name
GINGER CREEK DENTAL LLC
Practice address
24 Ginger Creek Pkwy
Glen Carbon, IL 62034-3502
Phone
(618) 692-1110
NPI assigned
Aug 9, 2010
Last updated
Aug 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David Guilbeault, D.M.D.NPI 1700894953
Title
Dentist
Phone
(618) 692-1110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019025281 IL Primary

Addresses

Primary practice location

24 Ginger Creek Pkwy
Glen Carbon, IL 62034-3502

Mailing address

24 Ginger Creek Pkwy
Glen Carbon, IL 62034-3502

National Provider Directory

National Provider Directory

Locations

24 Ginger Creek Pkwy
Glen Carbon, IL 62034
Phone (618) 655-1580

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281312000000",
    "number": "1023323623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 GINGER CREEK PKWY",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 GINGER CREEK PKWY",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343502",
            "telephone_number": "618-692-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GINGER CREEK DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-09",
        "last_updated": "2010-08-09",
        "status": "A",
        "authorized_official_last_name": "GUILBEAULT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "618-692-1110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Carbon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.