Evan Deuth Fiedler, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019027937 Issued in IL

Practice address

100 N McCoy St
Granville, IL 61326-9329

Phone

(815) 339-6888

Fax

(815) 339-6738

NPI assigned

Jun 30, 2009

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.

• Granville Dental, LLC

  • Dentist
  • Granville, IL
  • NPI 1821536368
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 25, 2010.

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269475200000",
    "number": "1104054022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N MCCOY ST",
            "address_2": "P.O. BOX 597",
            "city": "GRANVILLE",
            "state": "IL",
            "postal_code": "613269329",
            "telephone_number": "815-339-6888",
            "fax_number": "815-339-6738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MCCOY ST",
            "city": "GRANVILLE",
            "state": "IL",
            "postal_code": "613269329",
            "telephone_number": "815-339-6888",
            "fax_number": "815-339-6738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIEDLER",
        "first_name": "EVAN",
        "middle_name": "DEUTH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-30",
        "last_updated": "2010-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Axline'S Inc.
• Shawn E Bailey, MD
• Robert Bruce Dawe, D.D.S.
• Granville Dental, LLC
• Angella Marie Greenwood, APN, FNP, BC
• Damian W Grivetti, MD
• Toni Marie Lawley, R.PH.
• Mendota Community Hospital

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.