Premier Dental of Mt Vernon PC

Primary specialty

DentistTaxonomy code 122300000X

License

019028108 Issued in IL

Legal business name

PREMIER DENTAL OF MT VERNON PC

Practice address

9 Cusumano Professional Plaza Dr
Mount Vernon, IL 62864-6736

Phone

(618) 315-6213

NPI assigned

Jan 4, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Carla Geha, DMDNPI 1780729384

Title

President/Dentist

Phone

(618) 315-6213

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carla Geha I

  • Dentist
  • Mount Vernon, IL
  • NPI 1780729384
  NPD (past) Authorized official

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

{
    "created_epoch": "1325635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325635200000",
    "number": "1932479235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1003",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628640021",
            "telephone_number": "618-315-6213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 CUSUMANO PROFESSIONAL PLAZA DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646736",
            "telephone_number": "618-315-6213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DENTAL OF MT VERNON PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-04",
        "last_updated": "2012-01-04",
        "status": "A",
        "authorized_official_last_name": "GEHA",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "618-315-6213",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Nicole Plummer, APRN
• Nicholas Pollmann
• Amanda Jo Porter, OTR/L
• Susan Christine Portner, RPT
• Erica Lyn Prater, MSN, APRN, FNP-BC
• Premise Health of Illinois Medical PC (Mount Vernon Health Center Mt Vernon)
• PRN Professionals Home Service LLC
• James E. Probst Jr., D.O.
• Professional Imaging Consultants, PC
• Progressive Housing, Inc.

• Dentist in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.