WEST SIDE FAMILY DENTISTRY, LTD
NPI 1245617570
Dentist - General Practice in Mendota, IL
About West Side Family Dentistry, Ltd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WEST SIDE FAMILY DENTISTRY, LTD (NPI 1245617570) is a healthcare organization registered as a general practice in Mendota, Illinois and active in the NPI registry since May 2015. The organization lists Keri Lynn Sundberg, Dentist/president, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
West Side Family Dentistry, Ltd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to West Side Family Dentistry, Ltd, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 West Side Family Dentistry, Ltd's NPI number?
The NPI number for West Side Family Dentistry, Ltd is 1245617570. It was assigned to this organization in the NPPES registry on May 6, 2015.
Where is West Side Family Dentistry, Ltd located?
West Side Family Dentistry, Ltd is located at 709 Plaza Dr, Mendota, IL 61342. The listed phone number is (815) 539-7004.
What is West Side Family Dentistry, Ltd's specialty?
The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.
Is West Side Family Dentistry, Ltd enrolled in Medicare?
Yes. West Side Family Dentistry, Ltd is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through West Side Family Dentistry, Ltd?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Oral Surgery) reassigns their Medicare billing to West Side Family Dentistry, Ltd. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for West Side Family Dentistry, Ltd was last updated on October 5, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# West Side Family Dentistry, Ltd · NPI 1245617570
General Practice organization in Mendota, Illinois. Organization record, active in the CMS NPPES registry since May 6, 2015.
## Identity
- **NPI:** 1245617570 (Entity type: Organization)
- **Enumerated:** May 6, 2015
- **Primary specialty:** Dentist - General Practice · taxonomy 1223G0001X
- **Organization subpart:** No
- **Authorized official:** Keri Sundberg, DENTIST/PRESIDENT
## Practice location
- **Address:** 709 PLAZA DR, Mendota, IL 61342-2457
- **Phone:** (815) 539-7004 · **Fax:** (815) 539-7060
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Oral Surgery) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 5, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1245617570) · Data from the CMS NPPES public registry.