Granville Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

019016044 Issued in IL

Legal business name

GRANVILLE DENTAL, LLC

Practice address

100 N McCoy St
Granville, IL 61326-9329

Phone

(815) 339-6888

NPI assigned

Feb 4, 2017

Last updated

Feb 4, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert Dawe, D.D.S.NPI 1366445025

Title

Owner

Phone

(815) 339-6888

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Robert Bruce Dawe, D.D.S.

  • General Practice Dentistry
  • Granville, IL
  • NPI 1366445025
  NPD (past) Authorized official
• Evan Deuth Fiedler, D.D.S.

  • General Practice Dentistry
  • Granville, IL
  • NPI 1104054022
  NPD (past)

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

{
    "created_epoch": "1486166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486166400000",
    "number": "1821536368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N MCCOY ST",
            "city": "GRANVILLE",
            "state": "IL",
            "postal_code": "613269329",
            "telephone_number": "815-339-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MCCOY ST",
            "city": "GRANVILLE",
            "state": "IL",
            "postal_code": "613269329",
            "telephone_number": "815-339-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANVILLE DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-04",
        "last_updated": "2017-02-04",
        "status": "A",
        "authorized_official_last_name": "DAWE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-339-6888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019016044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Axline's Inc. (Axline Pharmacy)
• Shawn E Bailey, MD
• Robert Bruce Dawe, D.D.S.
• Evan Deuth Fiedler, D.D.S.
• Thomas Edward Gray, LICENSED PRACTICAL N
• Angella Marie Greenwood, APN, FNP, BC
• Damian W Grivetti, MD
• Toni Marie Lawley, R.PH.
• Mendota Community Hospital (OSF Healthcare - Medical Group - Granville)

• Dentist in Granville, IL
• Providers in Granville, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2017; 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.