Individual provider Active NPI

Brittany Gilbreth, D.M.D

  • Dentist
  • O Fallon, IL
National Provider Identifier
1285049825
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019029804 Issued in IL
Practice address
741 W State St
Suite 1
O Fallon, IL 62269-1971
Phone
(618) 632-2282
NPI assigned
Jun 23, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019029804 IL Primary

Addresses

Primary practice location

741 W State St
Suite 1
O Fallon, IL 62269-1971

Mailing address

741 W State St
Suite 1
O Fallon, IL 62269-1971
Phone (618) 632-2282

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150923000739 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 3072820083

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019029804ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
The Dental Studio of Southern Illinois CurrentSince Apr 17, 2022 Accepting new patients
Bowman Dental Group Past Accepting new patients

Locations

741 W State St
Ste 1
O Fallon, IL 62269
Phone (618) 632-2282

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.

NPI Registry JSON

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1285049825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 W STATE ST",
            "address_2": "SUITE 1",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691971",
            "telephone_number": "618-632-2282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 W STATE ST",
            "address_2": "SUITE 1",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691971",
            "telephone_number": "618-632-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILBRETH",
        "first_name": "BRITTANY",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-23",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019029804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, IL

Sources for this page

Verify at the official NPI Registry.