NPIMap

Organization Active NPI

Gateway Dental Group, LLC

  • General Practice Dentistry
  • Troy, IL
National Provider Identifier
1437601283
Registry record updated Oct 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19-020938 Issued in IL
Legal business name
GATEWAY DENTAL GROUP, LLC
Practice address
606 Edwardsville Road
Troy, IL 62294
Phone
(618) 667-8020
Fax
(618) 667-8078
NPI assigned
Oct 27, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2016

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

Authorized official

Name
Dr. Richard R Boatman Jr., DMDNPI 1659439859
Title
Manager
Phone
(618) 667-8070

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 19-020938 IL Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 19-025636 IL

Addresses

Primary practice location

606 Edwardsville Road
Troy, IL 62294

Mailing address

606 Edwardsville Road
Troy, IL 62294
Phone (618) 667-8020

Other names 1

  • Troy Family Dental Doing business as

National Provider Directory

National Provider Directory

Locations

606 Edwardsville Rd
Troy, IL 62294
Phone (618) 667-8020

Practitioners & affiliated clinicians

Practitioners 2

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": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477526400000",
    "number": "1437601283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 EDWARDSVILLE ROAD",
            "city": "TROY",
            "state": "IL",
            "postal_code": "62294",
            "telephone_number": "618-667-8020",
            "fax_number": "618-667-8078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 EDWARDSVILLE ROAD",
            "city": "TROY",
            "state": "IL",
            "postal_code": "62294",
            "telephone_number": "618-667-8020",
            "fax_number": "618-667-8078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-27",
        "last_updated": "2016-10-27",
        "status": "A",
        "authorized_official_last_name": "BOATMAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "618-667-8070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19-020938",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19-025636",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Troy Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Troy, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; 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.