NPIMap

Organization Active NPI

Connecticut Dental Professionals, P.C.

Doing business as Greater Norwalk Family Dentistry

  • Dentist
  • Saint Louis, MO
National Provider Identifier
1861145583
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
CONNECTICUT DENTAL PROFESSIONALS, P.C.
Doing business as
Greater Norwalk Family Dentistry
Practice address
12647 Olive Blvd
Saint Louis, MO 63141-6393
Phone
(217) 540-8306
NPI assigned
Feb 2, 2022
Last updated
Feb 2, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CONNECTICUT DENTAL PROFESSIONALS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

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

Authorized official

Name
Hillary Thull
Title
Credentialing Coordinator
Phone
(217) 540-8946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

12647 Olive Blvd
Saint Louis, MO 63141-6393

Mailing address

1200 Network Centre Dr Ste 2
Effingham, IL 62401-4637

Other names 1

  • Greater Norwalk Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Connecticut Dental Professionals PC9 organizations share this tax ID, including this one
Part of
Connecticut Dental Professionals PC

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1643760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643760000000",
    "number": "1861145583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NETWORK CENTRE DR STE 2",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624014637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12647 OLIVE BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416393",
            "telephone_number": "217-540-8306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONNECTICUT DENTAL PROFESSIONALS, P.C.",
        "enumeration_date": "2022-02-02",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "THULL",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8946"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greater Norwalk Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2022; 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.