NPIMap

Organization Active NPI

Prestige Dental Care, LLC

  • General Practice Dentistry
  • Saint Louis, MO
National Provider Identifier
1174618045
Registry record updated Oct 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
013556 Issued in MO
Legal business name
PRESTIGE DENTAL CARE, LLC
Practice address
2915 S Brentwood Blvd
Saint Louis, MO 63144-2713
Phone
(314) 962-6622
Fax
(314) 961-2288
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2011

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

Authorized official

Name
Dr. Srdjan Ilic-Siljak, DMDNPI 1659339893
Title
Dentist
Phone
(314) 962-6622

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 013556 MO Primary

Addresses

Primary practice location

2915 S Brentwood Blvd
Saint Louis, MO 63144-2713

Mailing address

2915 S Brentwood Blvd
Saint Louis, MO 63144-2713
Phone (314) 962-6622

National Provider Directory

National Provider Directory

Locations

2915 S Brentwood Blvd
Saint Louis, MO 63144
Phone (314) 962-6622

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318291200000",
    "number": "1174618045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2915 S BRENTWOOD BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631442713",
            "telephone_number": "314-962-6622",
            "fax_number": "314-961-2288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 S BRENTWOOD BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631442713",
            "telephone_number": "314-962-6622",
            "fax_number": "314-961-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE DENTAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2011-10-11",
        "status": "A",
        "authorized_official_last_name": "ILIC-SILJAK",
        "authorized_official_first_name": "SRDJAN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "314-962-6622",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "013556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2011; 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.