Jeffrey C Whiteside, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019028074 Issued in IL

Practice address

2943 W White Oaks Dr
Springfield, IL 62704-6544

Phone

(217) 793-8899

NPI assigned

Jul 17, 2009

Sex

Male

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

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Lifetime Dental Care of Illinois, PC

  • General Practice Dentistry
  • Springfield, IL
  • NPI 1700099066
  NPD (past)
• Lifetime Dental Care of Illinois, PC

  • General Practice Dentistry
  • Springfield, IL
  • NPI 1720200074
  NPD (past)

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

{
    "created_epoch": "1247788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247788800000",
    "number": "1407086002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2943 W WHITE OAKS DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627046544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2943 W WHITE OAKS DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627046544",
            "telephone_number": "217-793-8899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITESIDE",
        "first_name": "JEFFREY",
        "middle_name": "C",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-17",
        "last_updated": "2009-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter White Jr., MD
• Sue Irene White, CERTIFIED OPTICIAN
• Pamela K. Whitehead, CRNA
• Brandt David Whitehurst, MD
• Melinda B Whitelock, NNP-BC
• Adam C Whitford, MA
• Bethann Whitford
• Dana Lynn Whitlock, COTA/L
• Whitney Musselman Inc Dba Move With Me Pediatric Therapy
• Cathy J Whitsell, CRNA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.