NPIMap

Organization Active NPI

Paul T Kundrick DDS,PC

  • General Practice Dentistry
  • Edwardsville, IL
National Provider Identifier
1316015753
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PAUL T KUNDRICK DDS,PC
Practice address
235A S Main St
Edwardsville, IL 62025-1921
Phone
(618) 656-0451
NPI assigned
Dec 2, 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. Paul KundrickNPI 1730378704
Title
Officer
Phone
(618) 656-0451

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X IL Primary

Addresses

Primary practice location

235A S Main St
Edwardsville, IL 62025-1921

Mailing address

235 A South Main Street
Edwardsville, IL 62025

National Provider Directory

National Provider Directory

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": "1165017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316015753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 A SOUTH MAIN STREET",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "62025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235A S MAIN ST",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620251921",
            "telephone_number": "618-656-0451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL T KUNDRICK DDS,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KUNDRICK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "618-656-0451",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwardsville, 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.