Advanced Dentistry of O'Fallon LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ADVANCED DENTISTRY OF O'FALLON LLC

Practice address

2990 Highway K
O Fallon, MO 63368-7861

Phone

(636) 978-7816

NPI assigned

Apr 14, 2025

Organization subpart

No

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

Authorized official

Name

Stacey Barnes

Title

Practice Manager

Phone

(636) 978-7816

Specialties & licenses 1

Addresses

Other names 1

• Advanced Dentistry of O'Fallon Doing business as

Locations

Practitioners 1

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

• Daniel Cusumano, DDS

  • Dentist
  • Kansas City, MO
  • NPI 1871032458
  NPD

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

{
    "created_epoch": "1744588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744588800000",
    "number": "1750176103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2990 HIGHWAY K",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633687861",
            "telephone_number": "636-978-7816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 HIGHWAY K",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633687861",
            "telephone_number": "636-978-7816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTISTRY OF O'FALLON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-14",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "636-978-7816"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dentistry of O'Fallon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in O Fallon, MO
• Providers in O Fallon, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2025; 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.