NPIMap

Organization Active NPI

Spring Valley Dental Associates LLC

  • Dentist
  • O'Fallon, IL
National Provider Identifier
1154040830
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SPRING VALLEY DENTAL ASSOCIATES LLC
Practice address
904 E Highway 50
O Fallon, IL 62269-2868
Phone
(186) 632-8471
NPI assigned
Aug 25, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

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

Authorized official

Name
Diana Lifritz
Title
Operations Manager of Credentialing
Phone
(636) 578-5027

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

904 E Highway 50
O Fallon, IL 62269-2868

Mailing address

1922 Edwardsville Club Plaza CT
Edwardsville, IL 62025-3717
Phone (888) 502-7339

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1661385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1154040830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1922 EDWARDSVILLE CLUB PLAZA CT",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253717",
            "telephone_number": "888-502-7339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 E HIGHWAY 50",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692868",
            "telephone_number": "186-632-8471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRING VALLEY DENTAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-25",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "LIFRITZ",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "OPERATIONS MANAGER OF CREDENTIALING",
        "authorized_official_telephone_number": "636-578-5027"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; 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.