Brian Anthony Prudent, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.025580 Issued in IL

Practice address

1828 Avenue of the Cities
Moline, IL 61265-4858

Phone

(309) 764-0008

Fax

(309) 764-0059

NPI assigned

Jan 25, 2007

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

State licenses

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.

• Myotech, LLC

  • General Practice Dentistry
  • Moline, IL
  • NPI 1811132467
  NPD (past)
• QC Cpap Direct, LLC

  • Durable Medical Equipment & Medical Supplies
  • Moline, IL
  • NPI 1841685500
  NPD (past)

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432857600000",
    "number": "1528114675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1828 AVENUE OF THE CITIES",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612654858",
            "telephone_number": "309-764-0008",
            "fax_number": "309-764-0059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1828 AVENUE OF THE CITIES",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612654858",
            "telephone_number": "309-764-0008",
            "fax_number": "309-764-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDENT",
        "first_name": "BRIAN",
        "middle_name": "ANTHONY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2015-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.025580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Precedence Care Coordination Entity
• Premier Mental Health Services
• Gregory Arnold Prickett, D.D.S.
• Progress Non-Medical Transportation
• Progressive Home Wound Care, Inc
• Psi Health Care Inc (Rotech)
• Psychological Services in the Quad Cities, PC (Psi)
• James J Pugliano, LCSW
• Pulse Counseling & Wellness Center PLLC
• Sanjeev Puri, M.D.

• General Practice Dentistry in Moline, IL
• Providers in Moline, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; 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.