Market Street Family Dentist, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MARKET STREET FAMILY DENTIST, PC

Practice address

212 E Market St
Troy, IL 62294-1512

Phone

(618) 667-6101

NPI assigned

Jan 2, 2020

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

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 1750127601
  NPD tax ID

Locations

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": "1577923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690156800000",
    "number": "1770122194",
    "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": "212 E MARKET ST",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622941512",
            "telephone_number": "618-667-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARKET STREET FAMILY DENTIST, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-02",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-19",
        "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": []
}

• Makayla Lovelace
• Rodney L Lupardus, M.D.
• M Amin Zaman MD SC (First Care 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
• Leanne M McDonald

• 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 24, 2023; 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.