NPIMap

Organization Active NPI

Center for Oral and Maxillofacial Surgery, P.C.

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Belleville, IL
National Provider Identifier
1801000443
Registry record updated Jun 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
060000298 Issued in IL
Legal business name
CENTER FOR ORAL AND MAXILLOFACIAL SURGERY, P.C.
Practice address
10200 W Main St
Signal Hill Medical BLDG
Belleville, IL 62223-1408
Phone
(618) 397-2464
Fax
(618) 398-4450
NPI assigned
May 10, 2007
Last updated
Jun 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2011

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

Authorized official

Name
Dr. Glenn A Miller, DDS MSNPI 1922198118
Title
Oral & Maxillofacial Surgeon
Phone
(618) 387-2464

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 060000298 IL Primary

Addresses

Primary practice location

10200 W Main St
Signal Hill Medical BLDG
Belleville, IL 62223-1408

Mailing address

10200 West Main
Signal Hill Medical BLDG
Belleville, IL 62223
Phone (618) 397-2464

National Provider Directory

National Provider Directory

Locations

101 W Schwarz St
Edwardsville, IL 62025
Phone (618) 656-4049

Practitioners & affiliated clinicians

Practitioners 5

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": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307059200000",
    "number": "1801000443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10200 WEST MAIN",
            "address_2": "SIGNAL HILL MEDICAL BLDG",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "62223",
            "telephone_number": "618-397-2464",
            "fax_number": "618-398-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10200 W MAIN ST",
            "address_2": "SIGNAL HILL MEDICAL BLDG",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622231408",
            "telephone_number": "618-397-2464",
            "fax_number": "618-398-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR ORAL AND MAXILLOFACIAL SURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2011-06-03",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ORAL & MAXILLOFACIAL SURGEON",
        "authorized_official_telephone_number": "618-387-2464",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "IL",
            "license": "060000298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2011; 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.