Active NPI
Edward J Monroe, DDS
- Dentist
- La Salle, IL
National Provider Identifier
1962598706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019023902
- Practice address
- 206 Marquette Street
Suite 310
La Salle, IL 61301 - Phone
- (815) 223-6013
- Fax
- (815) 223-1128
- NPI assigned
- Oct 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019023902 | IL | Primary |
Addresses
Primary practice location
206 Marquette Street
Suite 310
La Salle, IL 61301
Mailing address
206 Marquette Street
Suite 310
La Salle, IL 61301
Phone (815) 223-6013
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 1, 2017 through May 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019023902 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962598706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 MARQUETTE STREET",
"address_2": "SUITE 310",
"city": "LA SALLE",
"state": "IL",
"postal_code": "61301",
"telephone_number": "815-223-6013",
"fax_number": "815-223-1128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 MARQUETTE STREET",
"address_2": "SUITE 310",
"city": "LA SALLE",
"state": "IL",
"postal_code": "61301",
"telephone_number": "815-223-6013",
"fax_number": "815-223-1128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONROE",
"first_name": "EDWARD",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019023902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Salle, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.