Keri Lynn Sundberg, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019025531 Issued in IL

Practice address

West Side Family Dentistry, LTD.
709 Plaza Drive
Mendota, IL 61342

Phone

(815) 539-7004

Fax

(815) 539-7060

NPI assigned

Nov 20, 2006

Last updated

Oct 5, 2022By the provider in NPPES

Sex

Female

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• West Side Family Dentistry, LTD

  • General Practice Dentistry
  • Mendota, IL
  • NPI 1245617570
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1568536845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 PLAZA DRIVE",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "61342",
            "telephone_number": "815-539-7004",
            "fax_number": "815-539-7060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WEST SIDE FAMILY DENTISTRY, LTD.",
            "address_2": "709 PLAZA DRIVE",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "61342",
            "telephone_number": "815-539-7004",
            "fax_number": "815-539-7060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDBERG",
        "first_name": "KERI",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hollie Reppin
• Amanda J. Rogde, P.A.
• Francisco Javier Romero
• Rebecca C Salvani, M.D.
• David A Scholl, M.D.
• Superior Nursing, LTD.
• Tara N Van de Wyngaerde OD PC
• Jennifer Tomkiewicz
• Yessenia Torres, DC
• Tara Nicole Vandewyngaerde, O.D

• General Practice Dentistry in Mendota, IL
• Providers in Mendota, 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 Oct 5, 2022; 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.