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Ethan Thomas Grounds, DMD

Individual provider Active NPI General Practice Dentistry · Harrisburg, IL

NPI 1740710052 · NPPES record last updated Jan 2, 2024

Key facts

NPI
1740710052
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
019.031182 (IL)
Practice address
300 Small St Ste D
Harrisburg, IL 62946-3325
Phone
(618) 252-1725
NPI assigned
Jun 19, 2017
Sex
Male
Sole proprietor
No

Organizations & group practices 2

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
019.031182ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Ethan Grounds DMD PC Current
since Jan 7, 2024		 Accepting new patients
Justin Settle, D.M.D., P.C. Past Accepting new patients

Locations

300 Small St
Ste D
Harrisburg, IL 62946
Phone (618) 252-1725

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019.031182 IL Yes

Addresses

Primary practice location

300 Small St Ste D
Harrisburg, IL 62946-3325

Mailing address

300 Small St Ste D
Harrisburg, IL 62946-3325
Phone (618) 252-1725

Other practice location 1

1601 E DeYoung St
Marion, IL 62959-5015
Phone (618) 997-6405

Other providers in Harrisburg, IL

All providers in Harrisburg, IL · General Practice Dentistry in Illinois

Sources for this page

Verify at the official NPI Registry.