DR. BRANDON MECKELBERG (NPI# 1457871188) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457871188 |
| Entity Type | Individual |
| Full Name | DR. BRANDON MECKELBERG |
| Credential | DDS |
| Practice Address |
1902 N Prospect Ave Ste 1 Champaign IL 61822-1411 |
| Mailing Address |
N1838 N Silver Lake Rd Wautoma WI 54982-7208 |
| Practice Telephone | 2174082511 |
| Mailing Telephone | 9204009009 |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2017-06-23 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 019.031228 | IL | Dental Providers |
| Street Address |
1902 N PROSPECT AVE STE 1 |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61822-1411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770962375 | Eunsu Jung | Dentist | 1902 N Prospect Ave Ste 1, Champaign, IL 61822-1411 | 2015-05-28 |
| 1285288035 | Sara Shekari | Dentist | 1902 N Prospect Ave Ste 1, Champaign, IL 61822-1411 | 2019-07-30 |
| 1548772114 | Philco Dental Group LLC - Champaign | Dentist | 1902 N Prospect Ave Ste 1, Champaign, IL 61822-1411 | 2017-11-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083180830 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 2718 N Prospect Avenue, Champaign, IL 61822 | 2018-10-19 |
| 1487129730 | Siegfred T. Celis | Occupational Therapy Assistant | 1820 Oak Park Drive, Champaign, IL 61822 | 2018-10-12 |
| 1134633746 | Osf Healthcare System | Home Health | 1501 Interstate Dr Ste C, Champaign, IL 61822 | 2017-11-20 |
| 1386164200 | Carlo Sandico | Physical Therapist | 612 Corey Lane, Champagne, IL 61822 | 2017-06-21 |
| 1295270288 | Jennifer Lee Lugo | Registered Nurse | 3101 Fields South Dr., Champaign, IL 61822 | 2016-12-29 |
| 1902341209 | Jala Simmons | Behavioral Analyst | 4112 Fieldstone Rd, Suite B, Champaign, IL 61822 | 2016-12-22 |
| 1639552433 | Muhammad Ajmal | Internal Medicine | 1701 Curtis Road, Carle Clinic, Champaign, IL 61822 | 2015-06-30 |
| 1518363761 | Margaret A. Hallden | Hearing Instrument Specialist | 3354 Big Pine Trail #c, Audibel Hearing Aids, Champaign, IL 61822 | 2014-11-17 |
| 1801291638 | Kristen Karlsen | Pharmacist | 3114 Village Office Place, Champaign, IL 61822 | 2014-10-22 |
| 1649601543 | Jeff Chu | Optometrist | 507 W. Town Center Blvd, Champaign, IL 61822 | 2013-12-03 |
| Find all providers in zip 61822 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669994232 | George Khazoum | Dentist | 1905 Convenience Pl Ste A, Champaign, IL 61820-8927 | 2017-07-14 |
| 1184008708 | Seunghyun Jae | Dentist | 1905 W Springfield Ave, Champaign, IL 61821 | 2015-07-14 |
| 1700034089 | Leonor Cecilia Villalta | Dentist | 2547 W Springfield Ave Apt 2, Champaign, IL 61821-2821 | 2008-08-28 |
| 1619133105 | Jeffrey D Colin | Dentist | 703 S Neil St Ste B, Champaign, IL 61820-5236 | 2008-08-04 |
| 1801051552 | David Wesley Bacheller | Dentist | 305 W Clark St, Champaign, IL 61820-4638 | 2008-07-22 |
| 1992971477 | Lindsey A Hans | Dentist | 2918 Crossing Ct Ste A, Champaign, IL 61822-6100 | 2008-05-05 |
| 1114056272 | Erika Ynga | Dentist | 703 S Neil St, Champaign, IL 61820-5223 | 2007-03-05 |
| 1851420475 | Jim W Yu | Dentist | 1905 Convenience Pl, Suite A, Champaign, IL 61820-8926 | 2007-03-02 |
| 1194866699 | Bruce Gail Sammons | Dentist | 3003 Village Office Place, Champaign, IL 61822-7674 | 2007-02-09 |
| 1316001654 | James Robert Fleming | Dentist | 2004 Fox Dr, Suite F, Champaign, IL 61820-7336 | 2006-12-21 |
| Find all providers in CHAMPAIGN | ||||
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| 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.