Advanced Dental Care of Springfield LLP

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ADVANCED DENTAL CARE OF SPRINGFIELD LLP

Practice address

4701 Wabash Ave
Springfield, IL 62711-9694

Phone

(217) 546-3333

Fax

(217) 546-1110

NPI assigned

Dec 8, 2020

Last updated

Dec 8, 2020By 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

Dr. Matt Gordon Vanfdermolen, DDS

Title

Manager

Phone

(217) 546-3333

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 3

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.

• Matt Gordon Vandermolen, DDS

  • General Practice Dentistry
  • Springfield, IL
  • NPI 1023194487
  NPD
• Victoria Lynn Driskill, D.M.D.

  • General Practice Dentistry
  • Springfield, IL
  • NPI 1669688230
  NPD (past)
• Kevin Schlee, D.D.S.

  • General Practice Dentistry
  • Springfield, IL
  • NPI 1346527348
  NPD (past)

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

{
    "created_epoch": "1607385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607385600000",
    "number": "1356947030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 WABASH AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119694",
            "telephone_number": "217-546-3333",
            "fax_number": "217-546-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 WABASH AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119694",
            "telephone_number": "217-546-3333",
            "fax_number": "217-546-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL CARE OF SPRINGFIELD LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-08",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A",
        "authorized_official_last_name": "VANFDERMOLEN",
        "authorized_official_first_name": "MATT",
        "authorized_official_middle_name": "GORDON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "217-546-3333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER FOR MATT G VANDERMOLEN DDS",
            "identifier": "0190019785",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Springfield",
            "affiliation": "N",
            "address_1": "4701 Wabash Ave",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627119694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Adloff Place
• Stacie Adonis, DDS
• Kwame Adu-Affum
• Bhavani Adusumilli, MD
• Advanced Center for Pain and Rehab SC
• Advanced Foot & Ankle Care, LTD
• Advanced Healthcare Services, LLC
• Advanced Healthcare Services, LLC
• Advanced Medical Transport of Springfield Inc (Medics First)
• Advanced Wound Care LLC

• General Practice Dentistry in Springfield, IL
• Providers in Springfield, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.