Andrew Haddock, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019034015 Issued in IL

Practice address

636 W Jefferson St
Morton, IL 61550

Phone

(309) 263-8317

NPI assigned

May 30, 2018

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Andris Family Dental, LLC

  • Dental Clinic/Center
  • Morton, IL
  • NPI 1225493034
  NPD (past)
• La Clinica de Los Campesinos, Inc

  • Federally Qualified Health Center (FQHC)
  • Stevens Point, WI
  • NPI 1790786929

  Dentist

  NPD (past)

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 20, 2023.

{
    "created_epoch": "1527638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1073005708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 W JEFFERSON ST",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "61550",
            "telephone_number": "309-263-8317",
            "fax_number": "920-787-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 W JEFFERSON ST",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "61550",
            "telephone_number": "309-263-8317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDOCK",
        "first_name": "ANDREW",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-30",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019034015",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1001807-15",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grimm Holdings, LLC
• David Lynn Griner, OTR/L
• Carin Ness Grzelak, PSY.D.
• Lori Meints Gudat, NP
• McKenzie Lynn Gunther, MS
• Ronald Hake, MD
• Hope Elizabeth Hamm, SLP
• Karen Marie Hannah, D.C
• Lorrie R. Harmon, APN
• Elizabeth Anne Hayes, APN

• All providers in Morton, IL
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.