Prairie Circle Dental, P.C.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PRAIRIE CIRCLE DENTAL, P.C.

Practice address

703 N Niles Ave
Tuscola, IL 61953-1059

Phone

(217) 253-5216

Fax

(217) 253-4949

NPI assigned

Mar 3, 2007

Last updated

Aug 22, 2020By 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. Richard D. Davidson, DMDNPI 1952462749

Title

Owner

Phone

(217) 253-5216

Specialties & licenses 1

Addresses

Other names 1

• Dr. Richard D. Davidson Former legal business name

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.

• Richard D Davidson, D.M.D.

  • Dentist
  • Tuscola, IL
  • NPI 1952462749
  NPD (past) Authorized official
• Madalyn M Davidson, DMD

  • Dentist
  • New York, NY
  • NPI 1508065590
  NPD (past)

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

{
    "created_epoch": "1172880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912036385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 N NILES AVE",
            "city": "TUSCOLA",
            "state": "IL",
            "postal_code": "619531059",
            "telephone_number": "217-253-5216",
            "fax_number": "217-253-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 N NILES AVE",
            "city": "TUSCOLA",
            "state": "IL",
            "postal_code": "619531059",
            "telephone_number": "217-253-5216",
            "fax_number": "217-253-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE CIRCLE DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-253-5216",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Richard D. Davidson",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Nicholas Alexander Micka, D.C.
• Midwest Care Tuscola, LLC
• Mandi Miller, PT
• Shirley Moody, PA
• Petersen Health Enterprises LLC (Tuscola Rehabilitation & Health Care Center)
• Alison S Ray, APRN
• Nathan L Roberts, MD
• George Rotramel, DMD
• Sally J Salmons, MD
• Shopko Stores Operating Co LLC (Shopko Pharmacy 640)

• Clinic/Center in Tuscola, IL
• Providers in Tuscola, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.