Kenneth Glenn Rawson, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

019026796 Issued in IL

Practice address

2800 College Ave
Alton, IL 62002-4742

Phone

(618) 474-7291

Fax

(618) 474-7089

NPI assigned

Dec 27, 2006

Sex

Male

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

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.

• Southern Illinois University Edwardsville School of Dental Medicine

  • General Practice Dentistry
  • Alton, IL
  • NPI 1215912696
  NPD (past)
• Southern Illinois University Edwardsville School of Dental Medicine

  • Dentist
  • E St Louis, IL
  • NPI 1760467146
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1295890366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 COLLEGE AVE",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620024742",
            "telephone_number": "618-474-7120",
            "fax_number": "618-474-7089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 COLLEGE AVE",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620024742",
            "telephone_number": "618-474-7291",
            "fax_number": "618-474-7089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAWSON",
        "first_name": "KENNETH",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019026796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coral Andrea Ramos Ayala, MD
• Jennifer Michelle Rapini, DDS
• Rachael Rascop
• Amir Rasuli, DDS
• Daniel Thomas Rauch
• Christopher Rebuck, D.P.T.
• Mikaela Reddick, MSW,LSW
• Hunter C. Reed
• Jan Reed, BSN,RN
• Angel Reeed, AA

• Pediatric Dentistry in Alton, IL
• Providers in Alton, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; 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.