1. Home
  2. Directory
  3. Illinois
  4. Edwardsville
  5. Clinic Center
  6. NPI Profile

EDWARDSVILLE FAMILY DENTIST
NPI 1063899417
Clinic/Center - Dental in Edwardsville, IL

Active since May 05, 2015
1811 LINDENWOOD AVE, EDWARDSVILLE, IL 62025(618) 659-0456 Get Directions Write a Review

NPPES record last updated: July 24, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Edwardsville Family Dentist NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDWARDSVILLE FAMILY DENTIST (NPI 1063899417) is a healthcare organization registered as a dental in Edwardsville, Illinois and active in the NPI registry since May 2015. The organization lists Beau G Moody, Dentist/owner, as its authorized official.

NPPES Registry Identity

NPI1063899417
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NameEDWARDSVILLE FAMILY DENTIST
Location Address1811 LINDENWOOD AVEEdwardsville, IL 62025-2580
Mailing Address1811 Lindenwood AveEdwardsville, IL 62025-2580 · (618) 659-0456
Phone(618) 659-0456
Organization SubpartNo
Authorized OfficialBeau G MoodyDentist/owner · (618) 659-0456
Enumeration DateMay 5, 2015
Last NPPES UpdateJuly 24, 2023
NPPES CertifiedJuly 24, 2023
✔ NPI 1063899417 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
License✔ Licensed in IL · 019028093
1811 LINDENWOOD AVE, Edwardsville, IL 62025
Open in Google Maps ↗

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. RULA SABAH ODEH AMARIN DDS, MS
Dentist (Prosthodontics)
1811 LINDENWOOD AVE
EDWARDSVILLE, IL 62025
Madison County (618) 659-0456
DR. MICHAEL HUDSON DMD
Dentist (General Practice)
1811 LINDENWOOD AVE
EDWARDSVILLE, IL 62025
Madison County (618) 659-0456
DR. JAKE SCHEITER DMD
Dentist
1811 LINDENWOOD AVE
EDWARDSVILLE, IL 62025
Madison County (618) 659-0456
DR. BEAU G MOODY DMD
Dentist
1811 LINDENWOOD AVE
EDWARDSVILLE, IL 62025
Madison County (618) 659-0456

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Edwardsville Family Dentist's NPI number?

The NPI number for Edwardsville Family Dentist is 1063899417. It was assigned to this organization in the NPPES registry on May 5, 2015.

Where is Edwardsville Family Dentist located?

Edwardsville Family Dentist is located at 1811 Lindenwood Ave, Edwardsville, IL 62025. The listed phone number is (618) 659-0456.

What is Edwardsville Family Dentist's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.

When was this NPI record last updated?

The NPPES record for Edwardsville Family Dentist was last updated on July 24, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.