OrganizationActive
Associated Pediatric Dentistry, LLC
NPI 1235527490 · Pediatric Dentistry · O Fallon, IL
Provider details
- NPI number
- 1235527490
- Entity type
- Organization
- Primary specialty
- Pediatric DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Kevin Beyersdorfer, Vice President(618) 622-0212
Specialties & taxonomies
Dental Providers
Profile Score
Established profile(74/100 index)
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
4945 Stone Falls Ctr
Suite B
O Fallon, IL 62269-7801
Phone: (618) 622-0212
Approximate (ZIP-level) locationGet directions
Mailing address
4945 Stone Falls Ctr
O Fallon, IL 62269-7801
Registry dates
- Enumerated
- 2014-12-22
- Last updated
- 2014-12-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.