SPRINGFIELD PERIODONTICS LLC (NPI# 1649342999) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649342999 |
| Entity Type | Organization |
| Organization Name | SPRINGFIELD PERIODONTICS LLC |
| Practice Address |
2025 W Iles Ave Springfield IL 62704-4190 |
| Practice Telephone | 2177876761 |
| Practice Fax Number | 2177876611 |
| Mailing Telephone | 2177876761 |
| Mailing Fax Number | 2177876611 |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JAMES WILLIAM DAVIS (PERIODONTIST) |
| Authorized Official Telephone | 2177876761 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Street Address |
2025 W ILES AVE |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62704-4190 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528165743 | Hughes Chiropractic Healthcare Sc | Chiropractor | 2025 W Iles Ave, Suite A, Springfield, IL 62704-4197 | 2006-09-20 |
| 1164859765 | Nxt Level Wellness, LLC | Chiropractor | 2025 W Iles Ave, Springfield, IL 62704-4190 | 2013-09-27 |
| 1871816389 | James William Davis | Dentist | 2025 W Iles Ave, Suite F, Springfield, IL 62704-4190 | 2010-03-11 |
| 1013191956 | Todd J. Hughes | Chiropractor | 2025 W Iles Ave, Suite A, Springfield, IL 62704-4190 | 2007-12-27 |
| 1124236989 | Susan Marie Minder | Chiropractor | 2025 W Iles Ave, Suite B, Springfield, IL 62704-4190 | 2007-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902394901 | Hillary Haaker | Occupational Therapist | 2035 W Iles, Suite C, Springfield, ID 62704 | 2018-04-25 |
| 1871095364 | Edward Doyle Slifer Sr. | Pathology | 2117 Greenside Drive, Spring Field, IL 62704 | 2018-03-01 |
| 1598263345 | Santarelli & Feller Dental Group | Dentist | 1140 Rickard Road, Suite B, Springfield, IL 62704 | 2018-01-26 |
| 1447774757 | Lisa Ann Rogers | Developmental Therapist | 2101 Lexington Dr, Apt 3, Springfield, IL 62704 | 2017-07-28 |
| 1730611286 | Mindi Rowe | Occupational Therapist | 2508 County Rd 4 1/2 E, Springfield, IL 62704 | 2017-04-03 |
| 1366992208 | Jayme Jordan | Contractor | 2409 Westchester Blvd, Springfield, IL 62704 | 2016-10-04 |
| 1154793974 | Dina Payne | Social Worker | 917 Clocktower Drive, Suite 600, Springfield, IL 62704 | 2015-10-21 |
| 1770959819 | James R Reynolds | Hearing Instrument Specialist | 2347 W Monroe St, Springfield, IL 62704 | 2015-08-12 |
| 1336576495 | Emily Jane Dungey | Counselor | 920 S Spring St Ste 1300, Springfield, IL 62704 | 2013-10-03 |
| 1942552161 | Jeannie Marie Hundley | Specialist/Technologist, Other | 2921 Monvale Drive, Springfield, IL 62704 | 2012-10-11 |
| Find all providers in zip 62704 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720624307 | Deena Hadithi Dmd, PC. | Dentist | 7210 Old Keene Mill Rd Ste 3, Springfield, VA 22150-3442 | 2019-11-19 |
| 1487975231 | Anthony T Quinta | Dentist | 1795 Main St Ste 202, Springfield, MA 01103-1015 | 2010-06-16 |
| 1760624613 | Georges Traboulsi | Dentist | 5419 Backlick Rd., C, Springfield, VA 22151 | 2009-03-24 |
| 1346373347 | Jody Brian Vance | Dentist | 3331 E Montclair St Ste G, Springfield, MO 65804-4786 | 2007-03-13 |
| 1629130430 | John Bruno | Dentist | 6120 Brandon Ave Ste 211, Springfield, VA 22150-2504 | 2006-12-15 |
| 1952472011 | Timothy Brian Coffelt | Dentist | 301 N Fountain Ave, Springfield, OH 45504-2536 | 2006-11-12 |
| 1063424638 | Bruce S Wyman | Dentist | 6116 Rolling Road, Suite 312, Springfield, VA 22152-1512 | 2006-08-12 |
| 1295743318 | Brad Reese Burks | Dentist | 1355 E Bradford Pkwy Ste D, Springfield, MO 65804-4200 | 2006-08-04 |
| 1275058919 | Anthony T Quinta Dmd LLC | Dentist | 1795 Main Street, Suite 202, Springfield, MA 01103 | 2017-08-03 |
| 1871816389 | James William Davis | Dentist | 2025 W Iles Ave, Suite F, Springfield, IL 62704-4190 | 2010-03-11 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62704 |
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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.