Bryan M Goldesberry, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019-027825 Issued in IL

Practice address

1366 E Main St
Carbondale, IL 62901-3144

Phone

(618) 549-0208

Fax

(618) 549-0182

NPI assigned

Feb 13, 2009

Sex

Male

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

Practice roles

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

• Lifetime Dental Care of Illinois, PC

  • General Practice Dentistry
  • Carbondale, IL
  • NPI 1487867750
  NPD (past)

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

{
    "created_epoch": "1234483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323993600000",
    "number": "1598904591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1366 E MAIN ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013144",
            "telephone_number": "618-549-0208",
            "fax_number": "618-549-0182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1366 E MAIN ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013144",
            "telephone_number": "618-549-0208",
            "fax_number": "618-549-0182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDESBERRY",
        "first_name": "BRYAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-13",
        "last_updated": "2011-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-027825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Leigh Gleason
• Kristin Glenn, LPC
• Mary Jane Glisson Keller, ED.S., BCBA
• Jerry L Goddard, M.D.
• Wallace Adam Goforth, CRNA
• Portia Goodin, MA, CCC-SLP
• Theresa Aleise Goodin, MA-CCC-SLP
• Katie Ann Gossett, FNP-C
• Kenya Denise Govan
• Susan Elizabeth Grace, LCSW

• Dentist in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2011; 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.