Edwardsville Family Dentist
NPI 1063899417 · Dental Clinic/Center · Edwardsville, IL
Edwardsville Family Dentist is a Dental Clinic/Center organization in Edwardsville, IL (NPI 1063899417).
Provider details
- NPI number
- 1063899417
- Entity type
- Organization
- Primary specialty
- Dental Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Beau Moody, Dentist/Owner(618) 659-0456
- License
- 019028093 (IL)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2015-05-05
- Last updated
- 2023-07-24
- Certified
- 2023-07-24
Frequently asked questions
- What is Edwardsville Family Dentist's NPI number?
- Edwardsville Family Dentist's National Provider Identifier (NPI) is 1063899417, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Edwardsville Family Dentist?
- Edwardsville Family Dentist is classified in the NPPES registry as Dental Clinic/Center (Ambulatory Health Care Facilities).
- Where is Edwardsville Family Dentist located?
- Edwardsville Family Dentist's practice location on file with NPPES is 1811 Lindenwood Ave, Edwardsville, IL 62025-2580.
- What is Edwardsville Family Dentist's phone number?
- The practice phone number listed in the NPPES registry for Edwardsville Family Dentist is (618) 659-0456.
- Who is the authorized official for Edwardsville Family Dentist?
- The authorized official listed on Edwardsville Family Dentist's NPPES record is Beau Moody, Dentist/Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Edwardsville Family Dentist's NPI active?
- Yes — Edwardsville Family Dentist's NPI (1063899417) is active in the NPPES registry as of the last update on 2023-07-24.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.