NPIMap

Organization Active NPI

Illini Smiles Dental Care PC

  • General Practice Dentistry
  • Champaign, IL
National Provider Identifier
1205245693
Registry record updated Jul 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019026810 Issued in IL
Legal business name
ILLINI SMILES DENTAL CARE PC
Practice address
201 W Springfield Ave Ste 506
Champaign, IL 61820-6383
Phone
(217) 356-3335
NPI assigned
Aug 11, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2020

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

Authorized official

Name
Yudong Xu, DMD
Title
President
Phone
(217) 356-3335

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019026810 IL Primary

Addresses

Primary practice location

201 W Springfield Ave Ste 506
Champaign, IL 61820-6383

Mailing address

701 Devonshire Dr
D-1
Champaign, IL 61820-7337
Phone (217) 356-3335

National Provider Directory

National Provider Directory
Tax ID family
Illini Smiles Dental Care PC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

201 W Springfield Ave
Ste 506
Champaign, IL 61820
Phone (217) 351-1082

NPI Registry JSON

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

{
    "created_epoch": "1407715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595808000000",
    "number": "1205245693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 DEVONSHIRE DR",
            "address_2": "D-1",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618207337",
            "telephone_number": "217-356-3335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W SPRINGFIELD AVE STE 506",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618206383",
            "telephone_number": "217-356-3335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINI SMILES DENTAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-11",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A",
        "authorized_official_last_name": "XU",
        "authorized_official_first_name": "YUDONG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-356-3335",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 27, 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.