St..Charles Modern Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ST..CHARLES MODERN DENTAL LLC

Practice address

855 S Randall Rd
St Charles, IL 60174-1570

Phone

(630) 587-2700

NPI assigned

Mar 2, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Jeff Thomas

Title

President

Phone

(618) 532-4902

Specialties & licenses 1

Addresses

Tax ID family

St Charles Modern Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• St. Charles Modern Dental, LLC

  • General Practice Dentistry
  • St Charles, IL
  • NPI 1912220773
  NPD tax ID

Locations

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

{
    "created_epoch": "1267488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267488000000",
    "number": "1134442304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 S RANDALL RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601741570",
            "telephone_number": "630-587-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 S RANDALL RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601741570",
            "telephone_number": "630-587-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST..CHARLES MODERN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-02",
        "last_updated": "2010-03-02",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-532-4902",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Charles Modern Dental, LLC
• St. Charles NH LLC
• St. Charles Pain and Wellness Center, LLC
• St. Charles Podiatry Assoc
• St. Charles Service Corporation
• Ashley Stalter
• Jennifer Stanley
• Shannon Starr
• Timothy Staudacher, M.D.
• Stephanie Clorinda Stavropoulos

• General Practice Dentistry in St Charles, IL
• Providers in St Charles, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.