NPIMap

Organization Active NPI

Prairie Dental Associates, P.C.

  • General Practice Dentistry
  • Bloomington, IL
National Provider Identifier
1528253994
Registry record updated Sep 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PRAIRIE DENTAL ASSOCIATES, P.C.
Practice address
3220 Gerig Dr
Bloomington, IL 61704-6394
Phone
(309) 662-7722
NPI assigned
Sep 10, 2007
Last updated
Sep 10, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2007

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

Authorized official

Name
Dr. Richard A. Stephey, DDS
Title
Ceo
Phone
(309) 662-7722

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X IL Primary

Addresses

Primary practice location

3220 Gerig Dr
Bloomington, IL 61704-6394

Mailing address

3220 Gerig Dr
Bloomington, IL 61704-6394
Phone (309) 662-7722

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189382400000",
    "number": "1528253994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 GERIG DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046394",
            "telephone_number": "309-662-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 GERIG DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046394",
            "telephone_number": "309-662-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE DENTAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2007-09-10",
        "status": "A",
        "authorized_official_last_name": "STEPHEY",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-662-7722",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2007; 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.