Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1164529723 Deactivated / Inactive NPI Male Practitioner

Dr. Jared P Isom , DDS

Dentist - General Practice • Millstadt, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Jared Isom has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 17, 2006
NPI Deactivation Date December 10, 2018
Total Practice Duration ~12 Years of Practice (2006 – 2018)

Professional Overview & Biography Verified Profile Summary

Dr. Jared Isom, DDS was a registered Dentist - General Practice practicing in Millstadt, IL. Throughout an active medical career spanning 12 years, Dr. Isom provided care at the practice location at 200 W MILL ST until profile deactivation on 2018-12-10.

Practice Location & Contact Primary Location

Practice Address

200 W Mill St

Millstadt, IL 622601148

Telephone 6184761400

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Millstadt, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.0 Yrs
Regional Practice Density
2 Specialists

Practicing in Millstadt, IL (5581 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated December 10, 2018

Record deactivated on December 10, 2018

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 200 W MILL ST, MILLSTADT, IL 622601148 (Tel: 6184761400)

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Updated Business Mailing Address July 08, 2007

Registered at 200 W MILL ST, MILLSTADT, IL 622601148 (Tel: 6184761400)

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Provider Name / Credentials Updated July 08, 2007

Recorded as JARED ISOM, D.D.S.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist

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Initial NPI Registration & Enumeration September 17, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1164529723
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 17, 2006
Last Update: July 08, 2007
Deactivation Date: December 10, 2018

Mailing Address

200 W Mill St

Millstadt, IL 622601148

Phone: 6184761400

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.