Preston Street, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019.033734 Issued in IL

Practice address

1502 W Main St
Robinson, IL 62454-3819

Phone

(618) 544-2626

NPI assigned

Jun 28, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Robinson Smile Center LLC

  • General Practice Dentistry
  • Robinson, IL
  • NPI 1720669831
  NPD
• Jason Luchtefeld, DMD, LLC

  • General Practice Dentistry
  • Robinson, IL
  • NPI 1942577002
  NPD (past)

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

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1689306557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 W MAIN ST",
            "city": "ROBINSON",
            "state": "IL",
            "postal_code": "624543819",
            "telephone_number": "618-544-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 W MAIN ST",
            "city": "ROBINSON",
            "state": "IL",
            "postal_code": "624543819",
            "telephone_number": "618-544-2626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STREET",
        "first_name": "PRESTON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.033734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mandy Stafford, CCC-SLP
• Pete D Stavrides, MD
• Stephen M. Lathrop
• Norie Lynn Stephens-Bilyew, LCSW
• Jodi L Strauch, FNP
• April Suprenaut, BA
• Richard Swisher, LCSW
• Gary A Tennison, DO
• Chelsea Thacker, OTR
• The Residential Develpers, Inc.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.