Jonathan Anderson
Individual provider Active NPI Dental Hygienist · Gillespie, IL
NPI 1407584014 · NPPES record last updated Aug 11, 2022
Key facts
- NPI
- 1407584014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 020015714 (IL)
- Practice address
- 109 E Maple St
Gillespie, IL 62033-1473 - Phone
- (217) 839-4110
- Fax
- (217) 839-1538
- NPI assigned
- Aug 11, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020015714 | IL | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 020015714 | IL | Yes |
Addresses
Primary practice location
109 E Maple St
Gillespie, IL 62033-1473
Mailing address
205 Oakland Ave
Carlinville, IL 62626-1921
Other providers in Gillespie, IL
- Ageless RX Systems LLC
- Ageless RX Systems LLC
- Terry Allan
- Sheri Lynne Banovic
- Melinda Beisner
- Esha Bhatt
- Ashley Renee Brown
- Carol Candler
All providers in Gillespie, IL · Dental Hygienist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.