Active NPI
Sergey Dolgov
- Dentist
- Alton, IL
National Provider Identifier
1154715795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.030120
- Practice address
- 2800 College Ave
Alton, IL 62002-4742 - Phone
- (618) 747-7000
- NPI assigned
- Mar 21, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.030120 | IL | Primary |
Addresses
Primary practice location
2800 College Ave
Alton, IL 62002-4742
Mailing address
2800 College Ave
Alton, IL 62002-4742
Phone (618) 747-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151113001063 | MN | Practitioner - Oral Surgery | 0648580050 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.030120 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426896000000",
"number": "1154715795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2800 COLLEGE AVE",
"city": "ALTON",
"state": "IL",
"postal_code": "620024742",
"telephone_number": "618-747-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 COLLEGE AVE",
"city": "ALTON",
"state": "IL",
"postal_code": "620024742",
"telephone_number": "618-747-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOLGOV",
"first_name": "SERGEY",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-21",
"last_updated": "2015-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.030120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2015; 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.