NPIMap

Organization Active NPI

Associated Pediatric Dentistry LTD

  • Pediatric Dentistry
  • O'Fallon, IL
National Provider Identifier
1952497901
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
ASSOCIATED PEDIATRIC DENTISTRY LTD
Practice address
4945 Stone Falls Ctr
Suite B
O Fallon, IL 62269-7802
Phone
(618) 622-0212
Fax
(618) 622-1996
NPI assigned
Oct 5, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Kevin Charles Beyersdorfer, DDSNPI 1295814002
Title
Owner Dentist
Phone
(618) 622-0212

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X IL Primary

Addresses

Primary practice location

4945 Stone Falls Ctr
Suite B
O Fallon, IL 62269-7802

Mailing address

4945 Stone Falls Ctr
Suite B
O Fallon, IL 62269-7802
Phone (618) 622-0212

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": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1952497901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4945 STONE FALLS CTR",
            "address_2": "SUITE B",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697802",
            "telephone_number": "618-622-0212",
            "fax_number": "618-622-1996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4945 STONE FALLS CTR",
            "address_2": "SUITE B",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697802",
            "telephone_number": "618-622-0212",
            "fax_number": "618-622-1996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED PEDIATRIC DENTISTRY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BEYERSDORFER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "618-622-0212",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.