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PERIODONTICS OF SOUTHERN ILLINOIS NPI 1639224876


NPI Information

NPI: 1639224876
Provider Name: PERIODONTICS OF SOUTHERN ILLINOIS
Classification: Dentist - 1223P0300X
Entity Type: Organization

Specialization: Periodontics

Address:
#11 PARK PLACE
BELLEVILLE, IL
ZIP 62226
Phone: (618) 233-7300
Get Directions

PERIODONTICS OF SOUTHERN ILLINOIS is a periodontics dentist in Belleville, IL. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. PERIODONTICS OF SOUTHERN ILLINOIS NPI is 1639224876. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

#11 PARK PLACE
BELLEVILLE, IL
ZIP 62226-925
Phone: (618) 233-7300
Fax: (618) 233-7432

The provider's authorized official is Josepj A Renner .
The authorized official title is Owner and has the following contact phone number (618) 233-7300.

The enumeration date for this NPI number is 1/25/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223P0300XDentistPeriodonticsILLINOISNo
21223P0300XDentistPeriodonticsILLINOISNo
31223P0300XDentistPeriodonticsILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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