DR. SCOTT MICHAEL BIETSCH (NPI# 1902119837) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902119837 |
| Entity Type | Individual |
| Full Name | DR. SCOTT MICHAEL BIETSCH |
| Credential | D.M.D. |
| Practice Address |
402 S Lewis Ln Carbondale IL 62901-3547 |
| Mailing Address |
Po Box 577 109 California St Carterville IL 62818-0577 |
| Practice Telephone | 6185199200 |
| Mailing Telephone | 6189858221 |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2016-12-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 019.028399 | IL | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
021002781 | IL | Dental Providers |
| Street Address |
402 S LEWIS LN |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-3547 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023509932 | Audrey Fields | Dentist | 402 S Lewis Ln, Carbondale, IL 62901 | 2018-05-25 |
| 1669990396 | Arjun Gauba | Dentist | 402 S Lewis Ln, Carbondale, IL 62901 | 2017-09-01 |
| 1669917449 | Sahitya Chiramana | Dentist | 402 S Lewis Ln, Carbondale, IL 62901 | 2017-01-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| 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 |
|---|---|---|---|---|
| 1396084182 | Gary Michael Brown | Dentist | 660 Drury Rd, Carbondale, IL 62902-7463 | 2013-02-13 |
| 1902117336 | Valerie N Spivey | Dentist | 402 South Lewis Lane, Carbondale, IL 62901 | 2010-06-30 |
| 1174859870 | Shawnee Health Service & Development Corp | Dentist | 402 S. Lewis Lane, Carbondale, IL 62901 | 2009-10-30 |
| 1598904591 | Bryan M Goldesberry | Dentist | 1366 E Main St, Carbondale, IL 62901-3144 | 2009-02-13 |
| 1093838005 | Mark Alan Cook | Dentist | 60 S 8th St Unit 201, Carbondale, CO 81623-1929 | 2007-04-06 |
| 1609943091 | Virgil A Beadle | Dentist | #4 Crown Lane, Carbondale, IL 62903-7604 | 2006-11-29 |
| 1861596934 | Clifford G Neill | Dentist | 307 S University, Carbondale, IL 62901 | 2006-09-11 |
| 1972532398 | Charles Bernard Brown | Dentist | 58 8th Ave, Carbondale, PA 18407-2297 | 2006-06-30 |
| 1023008364 | Dwayne Gail Summers | Dentist | 1365 Douglas Dr, Carbondale, IL 62901-2583 | 2005-10-27 |
| 1710974795 | Jonathan W Burton | Dentist | 2250 N Reed Station Rd, Suite 201, Carbondale, IL 62901-8101 | 2005-10-04 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
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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.