Active NPI
Vasiliki Kytridou, D.D.S.
- Endodontics
- Alton, IL
National Provider Identifier
1194380741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 136000244
- Practice address
- 2800 College Avenue Southern Il University School of de
Building 285
Alton, IL 62002 - Phone
- (612) 474-7024
- Fax
- (618) 474-7249
- NPI assigned
- May 8, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 136000244 | IL | Primary |
Addresses
Primary practice location
2800 College Avenue Southern Il University School of de
Building 285
Alton, IL 62002
Mailing address
2800 College Avenue Southern Il University School of de
Building 285
Alton, IL 62002
Phone (612) 474-7120
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 |
|---|---|---|---|
| 136000244 | IL | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Siu Dental Associates | Past | Accepting new patients |
Organizations & group practices 1
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
- Edwardsville, IL
- NPI 1659957850
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703116800000",
"number": "1194380741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2800 COLLEGE AVENUE SOUTHERN IL UNIVERSITY SCHOOL OF DE",
"address_2": "BUILDING 285",
"city": "ALTON",
"state": "IL",
"postal_code": "62002",
"telephone_number": "612-474-7120",
"fax_number": "618-474-7249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 COLLEGE AVENUE SOUTHERN IL UNIVERSITY SCHOOL OF DE",
"address_2": "BUILDING 285",
"city": "ALTON",
"state": "IL",
"postal_code": "62002",
"telephone_number": "612-474-7024",
"fax_number": "618-474-7249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KYTRIDOU",
"first_name": "VASILIKI",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-08",
"last_updated": "2023-12-21",
"certification_date": "2023-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "IL",
"license": "136000244",
"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 Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.