NPIMap

Organization Active NPI

Affordable Dentistry Today, PC

Doing business as St. Charles Lifetime Dental

  • General Practice Dentistry
  • St Charles, IL
National Provider Identifier
1750503371
Registry record updated Oct 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019029509 Issued in IL
Legal business name
AFFORDABLE DENTISTRY TODAY, PC
Doing business as
St. Charles Lifetime Dental
Practice address
615 South Randall Road, Unit #110
St. Charles, IL 60174-1564
Phone
(630) 443-6635
Fax
(630) 443-6637
NPI assigned
May 3, 2007
Last updated
Oct 20, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
AFFORDABLE DENTISTRY TODAY, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 20, 2016

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

Authorized official

Name
Kim Zuber
Title
I & R Supervisor
Phone
(217) 540-5170

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 019029509 IL Primary

Addresses

Primary practice location

615 South Randall Road, Unit #110
St. Charles, IL 60174-1564

Mailing address

615 South Randall Road, Unit #110
St. Charles, IL 60174-1564
Phone (630) 443-6635

Other names 1

  • St. Charles Lifetime Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Affordable Dentistry Today PC13 organizations share this tax ID, including this one
Part of
Affordable Dentistry Today PC

Other organizations with this tax ID 12

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

Locations

615 S Randall Rd
Ste 110
St Charles, IL 60174
Phone (630) 443-6635

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476921600000",
    "number": "1750503371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 SOUTH RANDALL ROAD, UNIT #110",
            "city": "ST. CHARLES",
            "state": "IL",
            "postal_code": "601741564",
            "telephone_number": "630-443-6635",
            "fax_number": "630-443-6637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 SOUTH RANDALL ROAD, UNIT #110",
            "city": "ST. CHARLES",
            "state": "IL",
            "postal_code": "601741564",
            "telephone_number": "630-443-6635",
            "fax_number": "630-443-6637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFORDABLE DENTISTRY TODAY, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AFFORDABLE DENTISTRY TODAY, PC",
        "enumeration_date": "2007-05-03",
        "last_updated": "2016-10-20",
        "status": "A",
        "authorized_official_last_name": "ZUBER",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "I & R SUPERVISOR",
        "authorized_official_telephone_number": "217-540-5170"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019029509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Charles Lifetime Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; 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.