NPIMap

Organization Active NPI

Dental Professionals of Illinois, P.C.

  • General Practice Dentistry
  • Champaign, IL
National Provider Identifier
1114149473
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.
Practice address
1905 Convenience Place
Suite a
Champaign, IL 61820
Phone
(217) 355-5165
Fax
(217) 355-5189
NPI assigned
May 3, 2007
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 DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1905 Convenience Place
Suite a
Champaign, IL 61820

Mailing address

1905 Convenience Place
Suite a
Champaign, IL 61820
Phone (217) 355-5165

Other names 1

  • Creative Smiles Dental Care Doing business as

National Provider Directory

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

Organizations with this tax ID in the same state 24

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

View all 24

Locations

1905 Convenience Pl
Ste A
Champaign, IL 61820
Phone (217) 275-5813

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1114149473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 CONVENIENCE PLACE",
            "address_2": "SUITE A",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "61820",
            "telephone_number": "217-355-5165",
            "fax_number": "217-355-5189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 CONVENIENCE PLACE",
            "address_2": "SUITE A",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "61820",
            "telephone_number": "217-355-5165",
            "fax_number": "217-355-5189"
        }
    ],
    "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creative Smiles Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Champaign, 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.