Signature Family Dental

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SIGNATURE FAMILY DENTAL

Practice address

1170 Belt Line Rd
Collinsville, IL 62234-4372

Phone

(618) 345-1400

NPI assigned

May 3, 2019

Organization subpart

No

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

Authorized official

Name

Heather Danielle Mahassek, DMD

Title

Owner

Phone

(618) 709-2934

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heather Danielle Taylor, DMD

  • Dentist
  • Collinsville, IL
  • NPI 1003291162
  NPD

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

{
    "created_epoch": "1556841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556841600000",
    "number": "1306401591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1170 BELT LINE RD",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622344372",
            "telephone_number": "618-345-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1170 BELT LINE RD",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622344372",
            "telephone_number": "618-345-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIGNATURE FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-03",
        "last_updated": "2019-05-03",
        "status": "A",
        "authorized_official_last_name": "MAHASSEK",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "DANIELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-709-2934",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1003291162",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlie Rebecca Schuessler
• Erin Lee Searfoss, OD
• Gerald A Semanek, RPH
• Amy Marie Shea
• Emily Marie Shepherd, PHARM. D.
• Sincere Medical Service
• Natalie Rae Sipole
• Danielle Sircle
• Judy P Sledge, LCPC CEAP
• Michael Sly

• All providers in Collinsville, IL
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2019; 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.