NPIMap

Organization Active NPI

Humbert Road Dentistry

  • Dentist
  • Alton, IL
National Provider Identifier
1942501911
Registry record updated Nov 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019013894 Issued in IL
Legal business name
HUMBERT ROAD DENTISTRY
Practice address
4119 Humbert Rd
Alton, IL 62002-7116
Phone
(618) 465-8100
Fax
(618) 462-3530
NPI assigned
Nov 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2010

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

Authorized official

Name
Dawn Michelle Shudt
Title
Office Manager
Phone
(618) 465-8100

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 019028117 IL
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 19020630 IL
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 019013894 IL Primary

Addresses

Primary practice location

4119 Humbert Rd
Alton, IL 62002-7116

Mailing address

4119 Humbert Rd
Alton, IL 62002-7116
Phone (618) 465-8100

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1289174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289174400000",
    "number": "1942501911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4119 HUMBERT RD",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620027116",
            "telephone_number": "618-465-8100",
            "fax_number": "618-462-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4119 HUMBERT RD",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620027116",
            "telephone_number": "618-465-8100",
            "fax_number": "618-462-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBERT ROAD DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-08",
        "last_updated": "2010-11-08",
        "status": "A",
        "authorized_official_last_name": "SHUDT",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-465-8100"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028117",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "19020630",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019013894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; 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.