Innovation Dental and Implant LLC
Organization Active NPI Dentist · O Fallon, IL
NPI 1932029907 · NPPES record last updated Jul 20, 2026
Key facts
- NPI
- 1932029907
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- Legal business name
- INNOVATION DENTAL AND IMPLANT LLC
- Practice address
- 717 Insight Ave
O Fallon, IL 62269-2151 - Phone
- (618) 277-6550
- NPI assigned
- Jul 20, 2026
- Organization subpart
- No
Authorized official
- Name
- Diana Lifritz
- Title
- Director of Human Resources
- Phone
- (618) 873-7500
National Provider Directory
Locations
717 Insight Ave
O Fallon, IL 62269
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | Yes |
Addresses
Primary practice location
717 Insight Ave
O Fallon, IL 62269-2151
Mailing address
1922 Edwardsville Club Plaza CT
Edwardsville, IL 62025-3717
Phone (618) 277-6550
Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.