NPIMap

Organization Active NPI

Mid-Illinois Dental Clinic, LLC

  • Dental Clinic/Center
  • Taylorville, IL
National Provider Identifier
1144830621
Registry record updated Aug 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
MID-ILLINOIS DENTAL CLINIC, LLC
Practice address
101 S Cherokee St
Taylorville, IL 62568-2605
Phone
(217) 824-2201
NPI assigned
Aug 9, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2020

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

Authorized official

Name
Dr. Benjamin Patrick Sowle, DMDNPI 1265090260
Title
Owner
Phone
(217) 414-4919

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

101 S Cherokee St
Taylorville, IL 62568-2605

Mailing address

1211 Peachtree Dr
Chatham, IL 62629-8058
Phone (217) 414-4919

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1596931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596931200000",
    "number": "1144830621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 PEACHTREE DR",
            "city": "CHATHAM",
            "state": "IL",
            "postal_code": "626298058",
            "telephone_number": "217-414-4919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S CHEROKEE ST",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "625682605",
            "telephone_number": "217-824-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-ILLINOIS DENTAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-09",
        "last_updated": "2020-08-09",
        "certification_date": "2020-08-09",
        "status": "A",
        "authorized_official_last_name": "SOWLE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-414-4919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylorville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2020; 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.