Alivia Cao, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019.033624 Issued in IL

Practice address

2102 W Randolph St
Vandalia, IL 62471-1973

Phone

(618) 283-4900

NPI assigned

Jun 14, 2022

Last updated

Jun 14, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• 2102 Randolph Vandalia Professional, LLC

  • General Practice Dentistry
  • Vandalia, IL
  • NPI 1588532675
  NPD
• Dynamic Dental Group, P.C.

  • General Practice Dentistry
  • Vandalia, IL
  • NPI 1811062557
  NPD (past)

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

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1396475208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 N SOMERSET LN",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605177572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 W RANDOLPH ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711973",
            "telephone_number": "618-283-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAO",
        "first_name": "ALIVIA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-14",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.033624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brookstone Estates of Vandalia
• Mark Gregory Brunk, D.M.D.
• Robert Butts, MD
• Cains Drug Store Inc (Cain's Drug Store LTC)
• Cains Drug Store Inc (Cains Drug Store)
• Mattie Rose Carter
• Carl A Castle, DO
• Kevin Jay Childers, OD
• Jeremy R Clark, D.C.
• Community Resource Center

• Dentist in Vandalia, IL
• Providers in Vandalia, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; 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.