NPIMap

Organization Active NPI

Siu Dental Associates

  • General Practice Dentistry
  • Edwardsville, IL
National Provider Identifier
1659957850
Registry record updated Sep 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SIU DENTAL ASSOCIATES
Practice address
195 University Park Dr
Edwardsville, IL 62025-3645
Phone
(618) 650-5781
Fax
(618) 650-5790
NPI assigned
Mar 19, 2021
Last updated
Sep 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2024

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

Authorized official

Name
Elizabeth Noel Phelps
Title
Business Manager
Phone
(618) 474-7104

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Oral and Maxillofacial Pathology DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0106X

Addresses

Primary practice location

195 University Park Dr
Edwardsville, IL 62025-3645

Mailing address

2800 College Ave
BLDG 273
Alton, IL 62002-4700
Phone (618) 474-7100

National Provider Directory

National Provider Directory

Locations

2800 College Ave
Bldg 273
Alton, IL 62002
Phone (415) 966-7761

195 University Park Dr
Edwardsville, IL 62025
Phone (618) 650-5062

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726704000000",
    "number": "1659957850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 COLLEGE AVE",
            "address_2": "BLDG 273",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620024700",
            "telephone_number": "618-474-7100",
            "fax_number": "618-474-7150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 UNIVERSITY PARK DR",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253645",
            "telephone_number": "618-650-5781",
            "fax_number": "618-650-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIU DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-19",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "PHELPS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "NOEL",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "618-474-7104"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwardsville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; 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.