NPIMap

Individual provider Active NPI

David G. Guilbeault, D.M.D.

  • General Practice Dentistry
  • Glen Carbon, IL
National Provider Identifier
1700894953
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019-025281 Issued in IL
Practice address
24 Ginger Creek Pkwy
Glen Carbon, IL 62034-3502
Phone
(618) 692-1110
Fax
(618) 692-1112
NPI assigned
Aug 4, 2006
Last updated
Dec 18, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019-025281 IL Primary

Addresses

Primary practice location

24 Ginger Creek Pkwy
Glen Carbon, IL 62034-3502

Mailing address

24 Ginger Creek Parkway
Glen Carbon, IL 62034
Phone (618) 692-1110

Other identifiers 1

IdentifierTypeStateIssuer
102743MedicaidIL

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-025281ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Garyweinstein,DDS,PC General Practice PastSince Mar 23, 2015 Accepting new patients
WM J Miller DMD PC Past Accepting new patients

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576627200000",
    "number": "1700894953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 GINGER CREEK PARKWAY",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "62034",
            "telephone_number": "618-692-1110",
            "fax_number": "618-692-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 GINGER CREEK PKWY",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343502",
            "telephone_number": "618-692-1110",
            "fax_number": "618-692-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUILBEAULT",
        "first_name": "DAVID",
        "middle_name": "G.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-025281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102743",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Carbon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; 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.