Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Edwardsville Family Dentist

Organization Dental Clinic/Center · NPI 1063899417

Edwardsville Family Dentist is a Dental Clinic/Center in Edwardsville, Illinois. Licensed in Illinois. Registered with an NPI since 2015.

Licensed in
IL
In the registry since
2015

Practice location Address checks out

1811 Lindenwood Ave
Edwardsville, IL 62025-2580
Phone: (618) 659-0456
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Clinic/Center (primary) Taxonomy 261QD0000X · Licence 019028093 (IL)

Record details

NPI number1063899417
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Beau Moody — Dentist/Owner · (618) 659-0456
NPI enumeratedMay 5, 2015
Last updated in NPPESJuly 24, 2023
Certification dateJuly 24, 2023
Mailing address1811 Lindenwood Ave, Edwardsville, IL 62025-2580

Other providers in Edwardsville