Marc Conel Thevenin Jr., DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DDS-10298 Issued in IA

Practice address

5270 Elmore Ave Ste 4
Davenport, IA 52807-3437

Phone

(563) 209-9000

NPI assigned

Jun 9, 2011

Last updated

Nov 27, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Marc C Thevenin Jr. PC

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1588179311
  NPD (past) Authorized official
• Patel-Shah Dental Iowa PLLC

  • General Practice Dentistry
  • Davenport, IA
  • NPI 1801583869
  NPD
• LM Smiles PLLC

  • General Practice Dentistry
  • Davenport, IA
  • NPI 1437616919
  NPD (past)
• Bronxcare Health System

  • Dental Clinic/Center
  • Bronx, NY
  • NPI 1851717219
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1811281637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2095 CLEMENTI LN",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605038579",
            "telephone_number": "909-810-6292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5270 ELMORE AVE STE 4",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073437",
            "telephone_number": "563-209-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16473 W 159th St",
            "address_purpose": "LOCATION",
            "city": "Lockport",
            "state": "IL",
            "postal_code": "604417961",
            "country_code": "US",
            "telephone_number": "815-221-4200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1770 Grand Concourse Apt 2F",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104575526",
            "country_code": "US",
            "telephone_number": "718-901-8110",
            "fax_number": "718-901-8121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEVENIN",
        "first_name": "MARC",
        "middle_name": "CONEL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-09",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019030600",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "DDS-10298",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Robert Young Center for Community Mental Health
• The Village Clinic, LLC
• The Weekend Clinic PLC
• The Wellnest of the Quad Cities
• Bounthong Toby Thepsoumphone, DC, LMT, BS
• Christine L Thoeming
• Thomas E. Kersting, DDS PC
• Aaron M Thomas, MSW, LCSW, LISW
• Angela Ellen Thomas, DC
• Kelly C Thomas, LMHC

• Dentist in Davenport, IA
• Providers in Davenport, IA by specialty
• Dentist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.