Bi-State Oral and Facial Surgery, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

021002736 Issued in IL

Legal business name

BI-STATE ORAL AND FACIAL SURGERY, LLC

Practice address

3555 College Ave
Alton, IL 62002-5009

Phone

(618) 462-1646

Fax

(618) 462-5721

NPI assigned

Jul 6, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Benjamin Jacob Schlott, MD, DMDNPI 1891938296

Title

Single Member

Phone

(618) 462-1646

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Benjamin Jacob Schlott, D.M.D , M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Alton, IL
  • NPI 1891938296
  Medicare reassignment NPD Authorized official
• Randall J Crammond, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Alton, IL
  • NPI 1215063573
  NPD (past)

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

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666742400000",
    "number": "1669824439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 COLLEGE AVE",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620025009",
            "telephone_number": "618-462-1646",
            "fax_number": "618-462-5721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 COLLEGE AVE",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620025009",
            "telephone_number": "618-462-1646",
            "fax_number": "618-462-5721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BI-STATE ORAL AND FACIAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-06",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A",
        "authorized_official_last_name": "SCHLOTT",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "JACOB",
        "authorized_official_title_or_position": "SINGLE MEMBER",
        "authorized_official_telephone_number": "618-462-1646",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021002736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891938296",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alex James Bertman
• Samantha Bettig, MSW,LSW
• Brian H Bettorf, COTA-L
• Sheri Betts
• Viwathna Bhuthimethee, M.D.
• Misty D Biciocchi, FNP
• Cody E Bilderback, FNP
• Rebecca Billings, ADN,RN
• Dennis Paul Billman, LPC
• Jami Binder

• Oral and Maxillofacial Surgery (Dentist) in Alton, IL
• Providers in Alton, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.