NPIMap

Organization Active NPI

Optim Dental LLC

  • Dentist
  • Springfield, IL
National Provider Identifier
1265820906
Registry record updated Jan 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019028802 Issued in IL
Legal business name
OPTIM DENTAL LLC
Practice address
907 S 6TH St
Springfield, IL 62703-2401
Phone
(217) 971-3432
Fax
(217) 971-3462
NPI assigned
Jan 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2015

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

Authorized official

Name
Srinivas Durshanapalli
Title
President
Phone
(203) 215-4687

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019028802 IL Primary

Addresses

Primary practice location

907 S 6TH St
Springfield, IL 62703-2401

Mailing address

907 S 6TH St
Springfield, IL 62703-2401
Phone (217) 971-3432

National Provider Directory

National Provider Directory

Locations

907 S 6th St
Springfield, IL 62703
Phone (217) 789-0289

Practitioners & affiliated clinicians

Practitioners 2

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": "1420416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420416000000",
    "number": "1265820906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032401",
            "telephone_number": "217-971-3432",
            "fax_number": "217-971-3462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032401",
            "telephone_number": "217-971-3432",
            "fax_number": "217-971-3462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIM DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-05",
        "last_updated": "2015-01-05",
        "status": "A",
        "authorized_official_last_name": "DURSHANAPALLI",
        "authorized_official_first_name": "SRINIVAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-215-4687"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2015; 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.