Meridian View Family Dental

Primary specialty

DentistTaxonomy code 122300000X

License

019025159 Issued in IL

Legal business name

MERIDIAN VIEW FAMILY DENTAL

Practice address

2133 South Illinois Route 157
Edwardsville, IL 62025

Phone

(618) 656-2006

Fax

(618) 656-2066

NPI assigned

Apr 1, 2008

Last updated

May 31, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amanda Henderson

Title

Business Assistant

Phone

(618) 288-6201

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338422400000",
    "number": "1629240569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 GINGER CREEK PKWY",
            "address_2": "PO BOX 430",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343502",
            "telephone_number": "618-288-6201",
            "fax_number": "618-288-6452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2133 SOUTH ILLINOIS ROUTE 157",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "62025",
            "telephone_number": "618-656-2006",
            "fax_number": "618-656-2066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERIDIAN VIEW FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2012-05-31",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "BUSINESS ASSISTANT",
        "authorized_official_telephone_number": "618-288-6201"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019025159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; 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.