NPIMap

Organization Active NPI

Galesburg Dental Care

  • Dental Clinic/Center
  • Galesburg, MI
National Provider Identifier
1912351446
Registry record updated Dec 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
2901021326 Issued in MI
Legal business name
GALESBURG DENTAL CARE
Practice address
357 E Michigan Ave
Galesburg, MI 49053-9763
Phone
(269) 665-9997
Fax
(269) 665-5088
NPI assigned
Apr 21, 2016
Last updated
Dec 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2016

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

Authorized official

Name
Dr. Shadi Khillah, DDSNPI 1124433396
Title
Dentist
Phone
(269) 806-4704

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 2901021326 MI Primary

Addresses

Primary practice location

357 E Michigan Ave
Galesburg, MI 49053-9763

Mailing address

357 E Michigan Ave
Galesburg, MI 49053-9763
Phone (269) 665-9997

National Provider Directory

National Provider Directory

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": "1461196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483056000000",
    "number": "1912351446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 E MICHIGAN AVE",
            "city": "GALESBURG",
            "state": "MI",
            "postal_code": "490539763",
            "telephone_number": "269-665-9997",
            "fax_number": "269-665-5088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 E MICHIGAN AVE",
            "city": "GALESBURG",
            "state": "MI",
            "postal_code": "490539763",
            "telephone_number": "269-665-9997",
            "fax_number": "269-665-5088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALESBURG DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-21",
        "last_updated": "2016-12-30",
        "status": "A",
        "authorized_official_last_name": "KHILLAH",
        "authorized_official_first_name": "SHADI",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "269-806-4704",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MI",
            "license": "2901021326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galesburg, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2016; 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.