Active NPI
Jessica Lee Stroud, DMD
- Dentist
- Sesser, IL
National Provider Identifier
1629399415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019028329
- Practice address
- 6294 State Highway 154
Sesser, IL 62884-2163 - Phone
- (618) 625-6679
- Fax
- (618) 625-5362
- NPI assigned
- Jun 16, 2010
- Last updated
- Aug 10, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019028329 | IL | Primary |
Addresses
Primary practice location
6294 State Highway 154
Sesser, IL 62884-2163
Mailing address
PO Box 155
Christopher, IL 62822-0155
Phone (618) 724-2401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019028329 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312934400000",
"number": "1629399415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 155",
"city": "CHRISTOPHER",
"state": "IL",
"postal_code": "628220155",
"telephone_number": "618-724-2401",
"fax_number": "618-724-4628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6294 STATE HIGHWAY 154",
"city": "SESSER",
"state": "IL",
"postal_code": "628842163",
"telephone_number": "618-625-6679",
"fax_number": "618-625-5362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STROUD",
"first_name": "JESSICA",
"middle_name": "LEE",
"name_prefix": "Mrs.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-16",
"last_updated": "2011-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019028329",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sesser, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.