NPIMap

Organization Active NPI

Periodontics of Southern Illinois

  • Periodontics
  • Belleville, IL
National Provider Identifier
1639224876
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
PERIODONTICS OF SOUTHERN ILLINOIS
Practice address
#11 Park Place
Belleville, IL 62226-2925
Phone
(618) 233-7300
Fax
(618) 233-7432
NPI assigned
Jan 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Josepj A Renner, D.D.S.
Title
Owner
Phone
(618) 233-7300

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X IL Primary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X IL
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X IL

Addresses

Primary practice location

#11 Park Place
Belleville, IL 62226-2925

Mailing address

#11 Park Place
Belleville, IL 62226-2925
Phone (618) 233-7300

National Provider Directory

National Provider Directory

Locations

11 Park Pl
Swansea, IL 62226
Phone (618) 233-7300

Practitioners & affiliated clinicians

Practitioners 3

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": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639224876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "#11 PARK PLACE",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622262925",
            "telephone_number": "618-233-7300",
            "fax_number": "618-233-7432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "#11 PARK PLACE",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622262925",
            "telephone_number": "618-233-7300",
            "fax_number": "618-233-7432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTICS OF SOUTHERN ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RENNER",
        "authorized_official_first_name": "JOSEPJ",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-233-7300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.