NPIMap

Organization Active NPI

Beltline Dental

  • General Practice Dentistry
  • Belleville, IL
National Provider Identifier
1538424577
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019025281 Issued in IL
Legal business name
BELTLINE DENTAL
Doing business as
Beltline Dental
Practice address
3601 N Belt W
Belleville, IL 62226
Phone
(618) 235-9101
Fax
(618) 235-9101
NPI assigned
Jul 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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

Authorized official

Name
Emilee Clark
Title
Credentialing Manager
Phone
(618) 207-3405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019025281 IL Primary

Addresses

Primary practice location

3601 N Belt W
Belleville, IL 62226

Mailing address

1922 Edwardsville Club Plaza
Edwardsville, IL 62025
Phone (618) 207-3405

Other names 1

  • Beltline Dental Doing business as

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.

NPI Registry JSON

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

{
    "created_epoch": "1341446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742774400000",
    "number": "1538424577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1922 EDWARDSVILLE CLUB PLAZA",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "62025",
            "telephone_number": "618-207-3405",
            "fax_number": "618-207-3405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 N BELT W",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "62226",
            "telephone_number": "618-235-9101",
            "fax_number": "618-235-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELTLINE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-05",
        "last_updated": "2025-03-24",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "EMILEE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "618-207-3405"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beltline Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; 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.