Active NPI
Poonam Jain
- General Practice Dentistry
- Staunton, IL
National Provider Identifier
1790799385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019-024969
- Practice address
- 109 W Main St
Staunton, IL 62088-1452 - Phone
- (618) 635-2280
- Fax
- (618) 635-2902
- NPI assigned
- Jul 28, 2006
- Last updated
- Jan 8, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019-024969 | IL | Primary |
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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-024969 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736294400000",
"number": "1790799385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 EVERGREEN DR",
"city": "STAUNTON",
"state": "IL",
"postal_code": "620882217",
"telephone_number": "618-978-1847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 W MAIN ST",
"city": "STAUNTON",
"state": "IL",
"postal_code": "620881452",
"telephone_number": "618-635-2280",
"fax_number": "618-635-2902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAIN",
"first_name": "POONAM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-28",
"last_updated": "2025-01-08",
"certification_date": "2025-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019-024969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staunton, IL
- Amber Marie Geilhausen, FNP
- Jennie Gipson, M.A., CCC-SLP
- Heritage Manor - Staunton, LLC (Heritage Health)
- Heritage Manor Staunton LLC (Heritage Health - Staunton)
- Highland Park CVS LLC (CVS Pharmacy #10774)
- Rajneesh Satish Jain, M.D.
- John B Caldieraro III, DMD, PC (Caldieraro Dental)
- Alicia Ann Keck, PHARMD
- Tammy Lynn Lambright, RN
- Christina P Lawrence
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.