Stateline Dentistry PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

STATELINE DENTISTRY PC

Practice address

3700 Il Route 173
Richmond, IL 60071-9614

Phone

(815) 701-6411

NPI assigned

Aug 15, 2025

Last updated

Aug 15, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amanda Roberts

Title

Office Manager

Phone

(815) 385-4140

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1755216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755216000000",
    "number": "1346126182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 IL ROUTE 173",
            "city": "RICHMOND",
            "state": "IL",
            "postal_code": "600719614",
            "telephone_number": "815-701-6411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 IL ROUTE 173",
            "city": "RICHMOND",
            "state": "IL",
            "postal_code": "600719614",
            "telephone_number": "815-701-6411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATELINE DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-15",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "815-385-4140"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2025; 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.