Lewis and Clark Community College

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

LEWIS AND CLARK COMMUNITY COLLEGE

Practice address

5800 Godfrey Rd
Godfrey, IL 62035-2466

Phone

(618) 468-4463

Fax

(618) 468-4408

NPI assigned

Nov 2, 2005

Organization subpart

No

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

Authorized official

Name

Dr. John Randall Miller, D.D.S.NPI 1871762773

Title

Clinic Supervisor

Phone

(618) 468-4414

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lewis and Clark Community College Dental Hygiene Clinic Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Randall Miller, D.D.S.

  • Dentist
  • Godfrey, IL
  • NPI 1871762773
  NPD (past) Authorized official
• Dana Renee Longmeyer, FNP

  • Family Nurse Practitioner
  • Godfrey, IL
  • NPI 1649491184
  NPD (past)

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497746077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 GODFREY RD",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620352466",
            "telephone_number": "618-468-4463",
            "fax_number": "618-468-4408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 GODFREY RD",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620352466",
            "telephone_number": "618-468-4463",
            "fax_number": "618-468-4408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWIS AND CLARK COMMUNITY COLLEGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "RANDALL",
        "authorized_official_title_or_position": "CLINIC SUPERVISOR",
        "authorized_official_telephone_number": "618-468-4414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9176253",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lewis and Clark Community College Dental Hygiene Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Larry W. Crocker DMD, PC
• Amy Christine Laughlin, RD
• Gerry Eugene Leclaire, R.PH.
• Melissa Kay Lee, FNP-C
• Andrea Lynn Leonard, CCC-SLP, MEA
• Ron Loflin, O.D.
• Sydnee Nicole Lollis
• Dana Renee Longmeyer, FNP
• Iona Lucas
• Keith Lyston, O.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.