Wood River Dental Group LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

WOOD RIVER DENTAL GROUP LLC

Practice address

1075 Harrison St
Wood River, IL 62095-1867

Phone

(618) 259-5200

NPI assigned

Jan 26, 2015

Organization subpart

No

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

Authorized official

Name

David Guilbeault, DMD

Title

Owner/Dentist

Phone

(618) 248-2038

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1422230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422230400000",
    "number": "1528458809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1922 EDWARDSVILLE CLUB PLAZA CT",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253717",
            "telephone_number": "618-248-2038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 HARRISON ST",
            "city": "WOOD RIVER",
            "state": "IL",
            "postal_code": "620951867",
            "telephone_number": "618-259-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOOD RIVER DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-26",
        "last_updated": "2015-01-26",
        "status": "A",
        "authorized_official_last_name": "GUILBEAULT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "618-248-2038",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Wood River, IL
• Providers in Wood River, 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 Jan 26, 2015; 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.