Katelyn Cecelia Genenbacher, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019032754 Issued in IL

Practice address

101 United Dr Ste 150
Collinsville, IL 62234-7439

Phone

(618) 345-7676

NPI assigned

Jul 9, 2020

Last updated

Jul 9, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dental Professionals of Illinois, P.C.

  dba Creating Smiles Cosmetic and Family Dentistry

  • Dentist
  • Collinsville, IL
  • NPI 1235876814
  NPD
• Creating Smiles LLC

  dba Creating Smiles Family and Cosmetic Dentistry

  • Durable Medical Equipment & Medical Supplies
  • Collinsville, IL
  • NPI 1083152243
  NPD (past)

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

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1255959847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 S 48TH ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623056097",
            "telephone_number": "217-617-6794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 UNITED DR STE 150",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622347439",
            "telephone_number": "618-345-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENENBACHER",
        "first_name": "KATELYN",
        "middle_name": "CECELIA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-09",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019032754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Elizabeth Gafford, LCSW
• Shelby F Garvey
• Gateway Anesthesia
• Gateway Dental Group of Illinois LLC
• Danica Lee Ann Geaslin Byler, LCPC
• Laura Gertz, OTR/L
• Shauna Padgett Gholston, M. ED
• Jeantielle M Gonzalez, M.S. CCC-SLP
• Rachel Gotshall
• Michelle Graham, MSW, LSW

• General Practice Dentistry in Collinsville, IL
• Providers in Collinsville, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; 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.