NPIMap

Organization Active NPI

Dental Professionals of Illinois, P.C.

Doing business as Mycharlestondentist.com

  • General Practice Dentistry
  • Charleston, IL
National Provider Identifier
1013139609
Registry record updated Jan 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Doing business as
Mycharlestondentist.com
Practice address
826 W Lincoln Avenue
Suite a
Charleston, IL 61920
Phone
(217) 345-1315
Fax
(217) 345-1291
NPI assigned
May 3, 2007
Last updated
Jan 7, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 7, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lindsay Bearden
Title
Ins Cood
Phone
(217) 540-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

826 W Lincoln Avenue
Suite a
Charleston, IL 61920

Mailing address

826 W Lincoln Avenue
Suite a
Charleston, IL 61920
Phone (217) 345-1315

Other names 1

  • Mycharlestondentist.com Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Family Dental Care of Illinois PC75 organizations share this tax ID, including this one
Part of
Heartland Family Dental Care of Illinois PC

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Locations

826 W Lincoln Ave
Ste A
Charleston, IL 61920
Phone (217) 345-1315

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389052800000",
    "number": "1013139609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 W LINCOLN AVENUE",
            "address_2": "SUITE A",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "61920",
            "telephone_number": "217-345-1315",
            "fax_number": "217-345-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 W LINCOLN AVENUE",
            "address_2": "SUITE A",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "61920",
            "telephone_number": "217-345-1315",
            "fax_number": "217-345-1291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF ILLINOIS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF ILLINOIS, P.C.",
        "enumeration_date": "2007-05-03",
        "last_updated": "2014-01-07",
        "status": "A",
        "authorized_official_last_name": "BEARDEN",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_title_or_position": "INS COOD",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mycharlestondentist.com",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.