DR. JOHN SPENCER PHELPS (NPI# 1033469036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033469036 |
| Entity Type | Individual |
| Full Name | DR. JOHN SPENCER PHELPS |
| Credential | DDS |
| Practice Address |
180 Stone Lake Dr Makanda IL 62958-2730 |
| Mailing Address |
180 Stone Lake Drive Makanda IL 62958-2730 |
| Practice Telephone | 6185494550 |
| Mailing Telephone | 6185494550 |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2012-09-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 019014490 | IL | Dental Providers |
| N | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
021000826 | IL | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598374837 | John K Phelps | Physical Therapist | 1425 E Main St Ste 600, Fredericksburg, TX 78624-5335 | 2020-07-22 |
| 1518116946 | John T Phelps | Dentist | 205 Waleska Road, Suite 2-a, Canton, GA 30114 | 2008-09-10 |
| 1649661158 | John Phelps | Social Worker | 2112 S Congress Ave Ste 104, Palm Springs, FL 33406-7670 | 2015-02-05 |
| 1104057181 | John Anthony Phelps | Marriage & Family Therapist | 189 Storrs Rd, Mansfield Center, CT 06250-1683 | 2009-08-07 |
| 1629130950 | John Yancy Phelps IIi | Obstetrics & Gynecology | 301 University Blvd, Galveston, TX 77555-5302 | 2006-12-14 |
| 1548280530 | John E Phelps | Specialist | 13203 N 103rd Ave, Suite C3, Sun City, AZ 85351-3028 | 2006-07-20 |
| 1093786147 | John Russell Phelps IIi | Dentist | 9011 N Meridian St, Indianapolis, IN 46260-5301 | 2006-01-27 |
| Street Address |
180 STONE LAKE DR |
| City | MAKANDA |
| State | IL |
| Zip Code | 62958-2730 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417345620 | Kelti Owens | Behavioral Analyst | 48 Jaros Ln, Apt. E, Makanda, IL 62958-2152 | 2014-12-23 |
| 1881821098 | Marissa Elizabeth Cooley | Contractor | 2 Private Road Pqq, Makanda, IL 62958-2400 | 2009-06-15 |
| 1477577724 | Accessible Environments | Durable Medical Equipment & Medical Supplies | 741 Contentment Rd, Makanda, IL 62958-2412 | 2006-07-27 |
| 1376193615 | Ramona Twellman | Community/Behavioral Health | 722 Giant City Rd, Makanda, IL 62958-3200 | 2019-09-18 |
| 1063503647 | Living In A Family Environment Management Corporation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3136 Myers Ln, Makanda, IL 62958-5200 | 2006-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376193615 | Ramona Twellman | Community/Behavioral Health | 722 Giant City Rd, Makanda, IL 62958-3200 | 2019-09-18 |
| 1417345620 | Kelti Owens | Behavioral Analyst | 48 Jaros Ln, Apt. E, Makanda, IL 62958-2152 | 2014-12-23 |
| 1881821098 | Marissa Elizabeth Cooley | Contractor | 2 Private Road Pqq, Makanda, IL 62958-2400 | 2009-06-15 |
| 1063503647 | Living In A Family Environment Management Corporation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3136 Myers Ln, Makanda, IL 62958-5200 | 2006-09-27 |
| 1477577724 | Accessible Environments | Durable Medical Equipment & Medical Supplies | 741 Contentment Rd, Makanda, IL 62958-2412 | 2006-07-27 |
| 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 |
|---|---|---|---|---|
| 1124629076 | Align Dental Group PC. | Dentist | 2605 Grand Ave Ste A, Waukegan, IL 60085-2410 | 2020-11-06 |
| 1881293801 | Wh Il Dental Pllc | Dentist | 18086 N. Kilpatrick Ave., Chicago, IL 60639 | 2020-10-21 |
| 1982201505 | Ashley Rodriguez | Dentist | 2208 N Mannheim Rd, Melrose Park, IL 60164-1837 | 2020-10-06 |
| 1831796853 | Shaista Hasan | Dentist | 1840 Harvest Ln, Glendale Heights, IL 60139-1939 | 2020-10-02 |
| 1558978841 | William Mitsos Dds | Dentist | 1291 S. 7th Ave, Kankakee, IL 60901 | 2020-09-30 |
| 1477160190 | Smilesbysangha LLC | Dentist | 118 Barrington Commons Ct Ste 201, Barrington, IL 60010-3259 | 2020-09-27 |
| 1477160331 | Samer Mosoof | Dentist | 9 Monroe Ct, Streamwood, IL 60107-1365 | 2020-09-24 |
| 1881208478 | Poornima Swamy Gangaji | Dentist | 760 N, Illinois Rte 59, Ste100, Naperville, IL 60563 | 2020-09-01 |
| 1275145534 | Moondrift Sleep Solutions, LLC | Dentist | 837 N Wilke Rd, Arlington Heights, IL 60005-1047 | 2020-08-18 |
| 1023629664 | Mockunas Dental PC | Dentist | 13530 S Route 59 Unit 120, Plainfield, IL 60544-5659 | 2020-08-16 |
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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.