NPIMap

Organization Active NPI

Matt Vandermolen DDS PC

Doing business as Advanced Dental Care of Springfield

  • General Practice Dentistry
  • Springfield, IL
National Provider Identifier
1841540168
Registry record updated Sep 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019019785 Issued in IL
Legal business name
MATT VANDERMOLEN DDS PC
Doing business as
Advanced Dental Care of Springfield
Practice address
4701 Wabash Ave
Springfield, IL 62711-9694
Phone
(217) 546-3333
Fax
(217) 546-1110
NPI assigned
Sep 13, 2012
Last updated
Sep 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2012

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

Authorized official

Name
Dr. Matt G Vandermolen, DDSNPI 1023194487
Title
President
Phone
(217) 546-3333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019019785 IL Primary

Addresses

Primary practice location

4701 Wabash Ave
Springfield, IL 62711-9694

Mailing address

4701 Wabash Ave
Springfield, IL 62711-9694
Phone (217) 546-3333

Other names 1

  • Advanced Dental Care of Springfield Doing business as

National Provider Directory

National Provider Directory

Locations

4701 Wabash Ave
Springfield, IL 62711
Phone (217) 546-3333

Practitioners & affiliated clinicians

Practitioners 1

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": "1347494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347494400000",
    "number": "1841540168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 WABASH AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119694",
            "telephone_number": "217-546-3333",
            "fax_number": "217-546-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 WABASH AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119694",
            "telephone_number": "217-546-3333",
            "fax_number": "217-546-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATT VANDERMOLEN DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-13",
        "last_updated": "2012-09-13",
        "status": "A",
        "authorized_official_last_name": "VANDERMOLEN",
        "authorized_official_first_name": "MATT",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-546-3333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019019785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dental Care of Springfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; 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.