Market Street Family Dentist, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MARKET STREET FAMILY DENTIST, PC

Practice address

550 Edwardsville Rd
Troy, IL 62294-1338

Phone

(618) 667-3446

NPI assigned

Jul 1, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Beau Moody, DMDNPI 1780917823

Title

President

Phone

(618) 667-6101

Specialties & licenses 1

Addresses

Other names 1

• MSFD Former legal business name

Tax ID family

Market Street Family Dentist PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Market Street Family Dentist, PC

  • Dental Clinic/Center
  • Troy, IL
  • NPI 1770122194
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Beau G Moody, DMD

  • Dentist
  • Edwardsville, IL
  • NPI 1780917823
  NPD Authorized official
• Mark F Porter, DMD

  • General Practice Dentistry
  • Troy, IL
  • NPI 1275669798
  NPD (past)

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

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719792000000",
    "number": "1750127601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 E MARKET ST",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622941512",
            "telephone_number": "618-667-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 EDWARDSVILLE RD",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622941338",
            "telephone_number": "618-667-3446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARKET STREET FAMILY DENTIST, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-667-6101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSFD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Eric Dean Lopatin, MD
• Makayla Lovelace
• Rodney L Lupardus, M.D.
• M Amin Zaman MD SC
• Madison County Reg II Spec Ed
• Market Street Family Dentist, PC
• Brooke Danielle Massa, MS, RD
• Fanny Archel Mateo
• Bethany Jo Mathis
• Gregory McDaniels, ATC

• Dental Clinic/Center in Troy, IL
• Providers in Troy, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; 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.