NPIMap

Organization Active NPI

Collinsville Pediatric Dentistry PLLC

Doing business as Gateway Little Smiles

  • Pediatric Dentistry
  • Collinsville, IL
National Provider Identifier
1295366896
Registry record updated Feb 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
COLLINSVILLE PEDIATRIC DENTISTRY PLLC
Doing business as
Gateway Little Smiles
Practice address
90 Crestmoor St
Collinsville, IL 62234-4951
Phone
(618) 346-8000
NPI assigned
Feb 1, 2020
Last updated
Feb 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2020

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

Authorized official

Name
Dr. Corey Hastings, DDS
Title
Owner/Dentist
Phone
(618) 346-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

90 Crestmoor St
Collinsville, IL 62234-4951

Mailing address

90 Crestmoor St
Collinsville, IL 62234-4951
Phone (618) 346-8000

Other names 1

  • Gateway Little Smiles Doing business as

National Provider Directory

National Provider Directory

Locations

90 Crestmoor St
Collinsville, IL 62234
Phone (618) 346-8000

Practitioners & affiliated clinicians

Practitioners 1

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": "1580515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580515200000",
    "number": "1295366896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 CRESTMOOR ST",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622344951",
            "telephone_number": "618-346-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 CRESTMOOR ST",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622344951",
            "telephone_number": "618-346-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLINSVILLE PEDIATRIC DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-01",
        "last_updated": "2020-02-01",
        "certification_date": "2020-02-01",
        "status": "A",
        "authorized_official_last_name": "HASTINGS",
        "authorized_official_first_name": "COREY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "618-346-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gateway Little Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Collinsville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 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.