Optim Dental LLC

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

Last updated

Jan 5, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Srinivas DurshanapalliNPI 1710265434

Title

President

Phone

(203) 215-4687

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Srinivas Rao Durshanapalli

  • Dentist
  • Indianapolis, IN
  • NPI 1710265434
  Authorized official Same address or phone
• Pratik Patel, D.M.D

  • Dentist
  • Springfield, IL
  • NPI 1598147027
  NPD (past)
• Ronald Matthew Ko, D.M.D.

  • Dentist
  • Puyallup, WA
  • NPI 1942652037
  NPD (past)

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": []
}

• Didacus Onodingene
• Douglas Onuscheck
• Obiora Edward Onwuameze, MD, MS, PHD
• Susan Aye Mya Oo, MD
• Kwaku Opoku, MD
• Optimal Chiropractic Health and Wellness Center (Optimal Chiropractic)
• Optimal Nutrition Experts LLC (ONE Nutrition)
• Kaitlyn Orear
• Vesselin Oreshkov, M.D.
• Danielle Oros, FNP-BC

• Dentist in Springfield, IL
• Providers in Springfield, IL by specialty
• Dentist in Illinois

• 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.