NPIMap

Organization Active NPI

Dental Professionals of Illinois, P.C.

Doing business as Avid Dental

  • General Practice Dentistry
  • Lindenhurst, IL
National Provider Identifier
1265125033
Registry record updated May 30, 2023
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
Avid Dental
Practice address
2246 E Grand Ave
Lindenhurst, IL 60046-7522
Phone
(847) 265-6444
NPI assigned
May 30, 2023
Last updated
May 30, 2023By 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 May 30, 2023

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

Authorized official

Name
Courtney Monteith
Title
Credentialing
Phone
(217) 764-8609

Specialties & licenses 1

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

Addresses

Primary practice location

2246 E Grand Ave
Lindenhurst, IL 60046-7522

Mailing address

2246 E Grand Ave
Lindenhurst, IL 60046-7522

Other names 1

  • Avid Dental 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

NPI Registry JSON

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

{
    "created_epoch": "1685404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685404800000",
    "number": "1265125033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2246 E GRAND AVE",
            "city": "LINDENHURST",
            "state": "IL",
            "postal_code": "600467522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2246 E GRAND AVE",
            "city": "LINDENHURST",
            "state": "IL",
            "postal_code": "600467522",
            "telephone_number": "847-265-6444"
        }
    ],
    "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": "2023-05-30",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A",
        "authorized_official_last_name": "MONTEITH",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "217-764-8609"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avid Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lindenhurst, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; 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.