DRS Selberg & Rice PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

DRS SELBERG & RICE PLLC

Practice address

4945 Stone Falls Ctr Ste B
O Fallon, IL 62269-7801

Phone

(618) 622-0212

NPI assigned

Jan 2, 2019

Organization subpart

No

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

Authorized official

Name

Lydie Fritz

Title

Business Administrator

Phone

(618) 622-2916

Specialties & licenses 1

Addresses

Other names 1

• Associated Pediatric Dentistry Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1546387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638748800000",
    "number": "1710450754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4945 STONE FALLS CTR STE B",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697801",
            "telephone_number": "618-622-0212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4945 STONE FALLS CTR STE B",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697801",
            "telephone_number": "618-622-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS SELBERG & RICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-02",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A",
        "authorized_official_last_name": "FRITZ",
        "authorized_official_first_name": "LYDIE",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "618-622-2916"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "PROTESTANT MEMORIAL MEDICAL CENTER, INC.",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4500 Memorial Dr",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Associated Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Associated Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jakia Douglas
• Mara Grace Downing, MD
• Dr Mukaia Mitchom Lockett LLC
• Susan Grace Drabing, FNP-BC
• Dawn Drewes, APN
• Vincent Joseph Duenas, MD
• Victoria Dunahee
• Ella M. Duncan, LCSW
• Caitlyn Elizabeth Durfee
• Sarah Ann Durnell, FNP

• Pediatric Dentistry in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; 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.