LINCOLN PLACE DENTAL PC (NPI# 1417221532) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417221532 |
| Entity Type | Organization |
| Organization Name | LINCOLN PLACE DENTAL PC |
| Practice Address |
114 Lincoln Place Ct Belleville IL 62221-5884 |
| Practice Telephone | 6182579189 |
| Practice Fax Number | 6182579253 |
| Mailing Telephone | 6182579189 |
| Mailing Fax Number | 6182579253 |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2012-03-07 |
| Authorized Official Name | DR. GERALD WAYNE DORTCH (OWNER) |
| Authorized Official Telephone | 6182579189 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
019016287 | IL | Dental Providers |
| Street Address |
114 LINCOLN PLACE CT |
| City | BELLEVILLE |
| State | IL |
| Zip Code | 62221-5884 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679134829 | Dr. Cynthia C. Banderet, Dmd, PC | Clinic/Center | 2630 Mascoutah Ave., Suite A, Belleville, IL 62221 | 2019-06-27 |
| 1942763487 | John Joseph Oldani | Psychologist | Bassc - Belleville Area Special Services Cooperative, 2411 Pathways Crossing, Belleville, IL 62221 | 2019-04-11 |
| 1114497781 | Kendra D Edwards | Counselor | 900 Royal Height Rd Suite 2150, Belleville, IL 62221 | 2018-11-27 |
| 1326537358 | Barbara S Laidlaw | Counselor | 2362 Country Rd, Belleville, IL 62221 | 2018-05-04 |
| 1083133946 | Kierra Jackson | In Home Supportive Care | 2611 Sierra Drive Apt. F, Belleville, IL 62221 | 2017-09-12 |
| 1972022994 | Kathleen Denise Defranco | Speech-Language Pathologist | 2028 Lebanon Ave., Belleville, IL 62221 | 2017-09-11 |
| 1700302270 | Mark Hofelich | Pharmacist | 515 Carlyle Avenue, Belleville, IL 62221 | 2017-08-16 |
| 1912422247 | Cherie Ann Klosterman | Psychologist | Belleville Area Special Services Cooperative, 2411 Pathways Crossing, Belleville, IL 62221 | 2017-08-08 |
| 1134391329 | Barbara Beckley | Home Health Aide | 2726 Cascade Lake Drive, Shiloh, IL 62221 | 2008-03-27 |
| 1356561666 | Belleville Area Spc Srv Co - Adm | Local Education Agency (LEA) | 2411 Pathways Crossing, Belleville, IL 62221 | 2007-04-27 |
| Find all providers in zip 62221 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417565748 | Robert Hails | Dentist | 3540 N Belt W Ste B, Belleville, IL 62226-5975 | 2020-07-22 |
| 1174055743 | Accurate Dental - Denture Inc | Dentist | 781 Sumpter Rd, Belleville, MI 48111-2916 | 2017-04-01 |
| 1316305063 | Lifetime Dental Care of Michigan, PC | Dentist | 6127 Rawsonville Rd, Suite 118, Belleville, MI 48111-2546 | 2016-02-09 |
| 1306212170 | Green Mount Dental, LLC | Dentist | 2810 Frank Scott Pkwy W Ste 800, Belleville, IL 62223-5007 | 2015-08-17 |
| 1306165303 | Atlantic Family Dentistry LLC | Dentist | 180 Washington Ave Fl 2, Belleville, NJ 07109-2541 | 2010-05-31 |
| 1336352608 | Affordable Dentistry Today, PC | Dentist | 5300 West Main, Belleville, IL 62226 | 2007-05-07 |
| 1427270073 | Affordable Dentistry Today, PC | Dentist | 1801 North Belt West, Suite C, Belleville, IL 62226 | 2007-05-03 |
| 1235353640 | Matt Raymod St. Eve | Dentist | 5700 W Main St, Belleville, IL 62226-4407 | 2007-04-13 |
| 1427170828 | Jerrold Ted Jacob | Dentist | 484 Washington Ave, Belleville, NJ 07109-2688 | 2007-04-04 |
| 1265570436 | Beth Rosenberg | Dentist | 9840 Haggerty Rd, Belleville, MI 48111-3443 | 2007-02-01 |
| Find all providers in BELLEVILLE | ||||
| City | BELLEVILLE |
| Zip Code | 62221 |
Please comment or provide details below to improve the information on LINCOLN PLACE DENTAL PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.