Great Rivers Dental P.C.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

GREAT RIVERS DENTAL P.C.

Practice address

708 E Bethalto Dr
Bethalto, IL 62010-1871

Phone

(618) 377-0044

NPI assigned

Jan 17, 2023

Last updated

Jan 17, 2023By 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. Matthew James McCullough, DMDNPI 1497894307

Title

President

Phone

(618) 339-7248

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 3

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.

• Matthew James McCullough, D.M.D.

  • Dentist
  • Greenville, IL
  • NPI 1497894307
  NPD Authorized official
• Audrey Brakensiek, DMD

  • General Practice Dentistry
  • Bethalto, IL
  • NPI 1437083482
  NPD (past)
• Sara Corrigan, DMD

  • Dentist
  • Saint Louis, MO
  • NPI 1285259796
  NPD (past)

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

{
    "created_epoch": "1673913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1932814720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 E BETHALTO DR",
            "city": "BETHALTO",
            "state": "IL",
            "postal_code": "620101871",
            "telephone_number": "618-377-0044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 E BETHALTO DR",
            "city": "BETHALTO",
            "state": "IL",
            "postal_code": "620101871",
            "telephone_number": "618-377-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT RIVERS DENTAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-17",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-339-7248",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.greatreiversdental.com",
            "affiliation": "N",
            "address_1": "708 E Bethalto Dr",
            "city": "Bethalto",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620101871",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristin Elmore, FNP-BC
• Empowerme Rehabilitation Illinois, LLC
• Fairview Heights Medical Group SC (Family Physicians Of Bethalto)
• Fairview Heights Medical Group SC (Family Physicians of Bethalto)
• First Class Chiropractic
• Amy Lynn Griffith, OTR/L
• Shelby Nicole Griggs, OD
• William P Hale, RPH.
• Hall Chiropractic LLC
• Craig Kenneth Harms, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.