NPIMap

Organization Active NPI

Southern Illinois University Edwardsville School of Dental Medicine

  • Dentist
  • E St Louis, IL
National Provider Identifier
1760467146
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
19018978 Issued in IL
Legal business name
SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE SCHOOL OF DENTAL MEDICINE
Practice address
411 E Broadway
E St Louis, IL 62201-2904
Phone
(618) 682-8318
Fax
(618) 474-7029
NPI assigned
Dec 8, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Dennis E Savoca, D.D.S., M.S.
Title
Associate Dean for Clinical Affairs
Phone
(618) 474-7090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 19018978 IL Primary

Addresses

Primary practice location

411 E Broadway
E St Louis, IL 62201-2904

Mailing address

2800 College Ave
Alton, IL 62002-4700
Phone (618) 474-7090

Other identifiers 1

IdentifierTypeStateIssuer
19018978MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Siue Nurse Managed HLTH6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

2800 College Ave
Alton, IL 62002
Phone (618) 474-7000

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760467146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 COLLEGE AVE",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620024700",
            "telephone_number": "618-474-7090",
            "fax_number": "618-474-7029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 E BROADWAY",
            "city": "E ST LOUIS",
            "state": "IL",
            "postal_code": "622012904",
            "telephone_number": "618-682-8318",
            "fax_number": "618-474-7029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE SCHOOL OF DENTAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SAVOCA",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ASSOCIATE DEAN FOR CLINICAL AFFAIRS",
        "authorized_official_telephone_number": "618-474-7090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "19018978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19018978",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in E St Louis, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.