Active NPI
Scott Christian Bares, DDS
- General Practice Dentistry
- Savanna, IL
National Provider Identifier
1164580734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019027024
- Practice address
- 401 Main St
Savanna, IL 61074 - Phone
- (815) 273-2212
- Fax
- (815) 273-1081
- NPI assigned
- Dec 5, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9200 | CO | |
| General Practice Dentistry | 1223G0001X | 019027024 | IL | Primary |
| Dentist | 122300000X | 019027024 | IL |
Addresses
Primary practice location
401 Main St
Savanna, IL 61074
Mailing address
401 Main St
Savanna, IL 61074
Phone (815) 273-2212
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9200 | CO | MD | Dentist |
| 019027024 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Keith Ruter LLC Dba Riverside Dental | General Practice | Past | Accepting new patients |
| Riverside Dental, PC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- Savanna, IL
- NPI 1750640439
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383177600000",
"number": "1164580734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 MAIN ST",
"city": "SAVANNA",
"state": "IL",
"postal_code": "61074",
"telephone_number": "815-273-2212",
"fax_number": "815-273-1081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 MAIN ST",
"city": "SAVANNA",
"state": "IL",
"postal_code": "61074",
"telephone_number": "815-273-2212",
"fax_number": "815-273-1081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BARES",
"first_name": "SCOTT",
"middle_name": "CHRISTIAN",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-05",
"last_updated": "2013-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "9200",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019027024",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019027024",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Savanna, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.