Poonam Jain
Individual provider Active NPI General Practice Dentistry · Staunton, IL
NPI 1790799385 · NPPES record last updated Jan 8, 2025
Key facts
- NPI
- 1790799385
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019-024969 (IL)
- Practice address
- 109 W Main St
Staunton, IL 62088-1452 - Phone
- (618) 635-2280
- Fax
- (618) 635-2902
- NPI assigned
- Jul 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-024969 | IL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019-024969 | IL | Yes |
Addresses
Primary practice location
109 W Main St
Staunton, IL 62088-1452
Mailing address
5 Evergreen Dr
Staunton, IL 62088-2217
Phone (618) 978-1847
Other providers in Staunton, IL
- Amber Marie Geilhausen
- Jennie Gipson
- Heritage Manor - Staunton, LLC
- Heritage Manor Staunton LLC
- Highland Park CVS LLC
- Rajneesh Satish Jain
- John B Caldieraro III, DMD, PC
- Alicia Ann Keck
- Tammy Lynn Lambright
- Christina P Lawrence
All providers in Staunton, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.