NPIMap

Organization Active NPI

Dynamic Dental Group, P.C.

  • General Practice Dentistry
  • Vandalia, IL
National Provider Identifier
1811062557
Registry record updated Dec 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
060003846 Issued in IL
Legal business name
DYNAMIC DENTAL GROUP, P.C.
Practice address
2102 W Randolph St
Vandalia, IL 62471-1973
Phone
(618) 283-4900
Fax
(618) 283-4963
NPI assigned
Nov 21, 2006
Last updated
Dec 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2016

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

Authorized official

Name
Dr. Bradley K. Dunn, D.M.DNPI 1619042165
Title
President/Owner
Phone
(618) 283-4900

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
General Practice Dentistry 1223G0001X 060003846 IL Primary

Addresses

Primary practice location

2102 W Randolph St
Vandalia, IL 62471-1973

Mailing address

2102 W Randolph St
Vandalia, IL 62471-1973
Phone (618) 283-4900

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481673600000",
    "number": "1811062557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2102 W RANDOLPH ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711973",
            "telephone_number": "618-283-4900",
            "fax_number": "618-283-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 W RANDOLPH ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711973",
            "telephone_number": "618-283-4900",
            "fax_number": "618-283-4963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC DENTAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2016-12-14",
        "status": "A",
        "authorized_official_last_name": "DUNN",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "618-283-4900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "060003846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vandalia, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; 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.