Active NPI
John Joseph Ebeling III, DDS
- General Practice Dentistry
- Saint Charles, MO
National Provider Identifier
1740773084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2018018570
- Practice address
- 1360 S 5TH St Ste 214
Saint Charles, MO 63301-2446 - Phone
- (636) 946-6747
- NPI assigned
- Jun 12, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2018018570 | MO | Primary |
Addresses
Primary practice location
1360 S 5TH St Ste 214
Saint Charles, MO 63301-2446
Mailing address
1360 S 5TH St Ste 214
Saint Charles, MO 63301-2446
Phone (636) 946-6747
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2018018570 | MO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528761600000",
"number": "1740773084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1360 S 5TH ST STE 214",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633012446",
"telephone_number": "636-946-6747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1360 S 5TH ST STE 214",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633012446",
"telephone_number": "636-946-6747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBELING",
"first_name": "JOHN",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-12",
"last_updated": "2018-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "2018018570",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Charles, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.