NPIMap

Organization Active NPI

Cedar Creek Dental Assoc

  • General Practice Dentistry
  • Highland, IL
National Provider Identifier
1275605305
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CEDAR CREEK DENTAL ASSOC
Practice address
380 Suppiger Way
Suite 3
Highland, IL 62249-1103
Phone
(618) 654-4551
Fax
(618) 654-8523
NPI assigned
Nov 14, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Bret W Gruender, D.M.D.NPI 1861563462
Title
President
Phone
(618) 654-4551

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 Dentistry 1223G0001X Primary

Addresses

Primary practice location

380 Suppiger Way
Suite 3
Highland, IL 62249-1103

Mailing address

380 Suppiger Way
Suite 3
Highland, IL 62249-1103
Phone (618) 654-4551

National Provider Directory

National Provider Directory

Locations

380 Suppiger Way
#3
Highland, IL 62249
Phone (618) 654-4551

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275605305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 SUPPIGER WAY",
            "address_2": "SUITE 3",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622491103",
            "telephone_number": "618-654-4551",
            "fax_number": "618-654-8523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 SUPPIGER WAY",
            "address_2": "SUITE 3",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622491103",
            "telephone_number": "618-654-4551",
            "fax_number": "618-654-8523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR CREEK DENTAL ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRUENDER",
        "authorized_official_first_name": "BRET",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-654-4551",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.