NPIMap

Organization Active NPI

The Dental Studio of Southern Illinois

  • Dental Clinic/Center
  • O Fallon, IL
National Provider Identifier
1598408783
Registry record updated May 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
THE DENTAL STUDIO OF SOUTHERN ILLINOIS
Practice address
741 W State St Ste 1
O Fallon, IL 62269-1971
Phone
(618) 632-2282
NPI assigned
Apr 15, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2022

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

Authorized official

Name
Brittany GilbrethNPI 1285049825
Title
Co-Owner
Phone
(618) 304-0998

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

741 W State St Ste 1
O Fallon, IL 62269-1971

Mailing address

741 W State St Ste 1
O Fallon, IL 62269-1971

National Provider Directory

National Provider Directory

Locations

741 W State St
Ste 1
O Fallon, IL 62269
Phone (618) 632-2282

Practitioners & affiliated clinicians

Practitioners 2

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": "1649980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651363200000",
    "number": "1598408783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 W STATE ST STE 1",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 W STATE ST STE 1",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691971",
            "telephone_number": "618-632-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DENTAL STUDIO OF SOUTHERN ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-15",
        "last_updated": "2022-05-01",
        "certification_date": "2022-05-01",
        "status": "A",
        "authorized_official_last_name": "GILBRETH",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "618-304-0998"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2022; 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.