NPIMap

Individual provider Active NPI

Megan Lynette Preville, DMD

  • Dentist
  • Centreville, IL
National Provider Identifier
1700035730
Registry record updated Apr 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019029730 Issued in IL
Practice address
6000 Bond Ave
Dental Clinic
Centreville, IL 62207-2328
Phone
(618) 332-2740
NPI assigned
Sep 15, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DD3187 NM
Student in an Organized Health Care Education/Training Program 390200000X
Dentist 122300000X 019029730 IL Primary

Addresses

Primary practice location

6000 Bond Ave
Dental Clinic
Centreville, IL 62207-2328

Mailing address

6000 Bond Ave
Dental Clinic
Centreville, IL 62207-2328
Phone (618) 332-2740

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

LicenseStateTypeSpecialty
019029730ILMDDentist
DD3187NMMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1221436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429228800000",
    "number": "1700035730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 BOND AVE",
            "address_2": "DENTAL CLINIC",
            "city": "CENTREVILLE",
            "state": "IL",
            "postal_code": "622072328",
            "telephone_number": "618-332-2740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 BOND AVE",
            "address_2": "DENTAL CLINIC",
            "city": "CENTREVILLE",
            "state": "IL",
            "postal_code": "622072328",
            "telephone_number": "618-332-2740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREVILLE",
        "first_name": "MEGAN",
        "middle_name": "LYNETTE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-15",
        "last_updated": "2015-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD3187",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019029730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centreville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; 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.