NPIMap

Organization Active NPI

Fauble Dental Healthcare Associates, PC

  • General Practice Dentistry
  • Quincy, IL
National Provider Identifier
1346261450
Registry record updated Jul 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019-021341 Issued in IL
Legal business name
FAUBLE DENTAL HEALTHCARE ASSOCIATES, PC
Doing business as
Advanced Dental Care
Practice address
4561 Maine St
Quincy, IL 62305-5851
Phone
(217) 228-1085
Fax
(217) 228-1089
NPI assigned
Jul 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2008

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

Authorized official

Name
Mrs. Diane V Lane
Title
Business Assistant
Phone
(217) 228-1085

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 019-021341 IL Primary

Addresses

Primary practice location

4561 Maine St
Quincy, IL 62305-5851

Mailing address

4561 Maine St
Quincy, IL 62305-5851
Phone (217) 228-1085

Other identifiers 1

IdentifierTypeStateIssuer
1004529MedicaidIL

Other names 1

  • Advanced Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

4561 Maine St
Quincy, IL 62305
Phone (217) 228-1085

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1346261450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4561 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623055851",
            "telephone_number": "217-228-1085",
            "fax_number": "217-228-1089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4561 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623055851",
            "telephone_number": "217-228-1085",
            "fax_number": "217-228-1089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAUBLE DENTAL HEALTHCARE ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2008-07-29",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "BUSINESS ASSISTANT",
        "authorized_official_telephone_number": "217-228-1085",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-021341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004529",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Quincy, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; 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.