NPIMap

Organization Active NPI

St. Louis Surgical Associates, LLC

  • Periodontics
  • Glen Carbon, IL
National Provider Identifier
1093064057
Registry record updated Nov 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
19025397 Issued in IL
Legal business name
ST. LOUIS SURGICAL ASSOCIATES, LLC
Practice address
24 Ginger Creek Pkwy
Glen Carbon, IL 62034-3502
Phone
(618) 655-1580
NPI assigned
Sep 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2015

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

Authorized official

Name
David Guilbeault, DMD
Title
Owner
Phone
(618) 643-9523

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 19025397 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

NPI Registry JSON

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

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448841600000",
    "number": "1093064057",
    "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": "618-655-1580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LOUIS SURGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-06",
        "last_updated": "2015-11-30",
        "status": "A",
        "authorized_official_last_name": "GUILBEAULT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-643-9523",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "19025397",
            "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 Nov 30, 2015; 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.