Philco Dental Group LLC - Mattoon

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PHILCO DENTAL GROUP LLC - MATTOON

Practice address

1011 Charleston Ave E
Mattoon, IL 61938-6226

Phone

(217) 235-5900

NPI assigned

Nov 3, 2017

Organization subpart

No

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

Authorized official

Name

Aaron Phillips

Title

Owner

Phone

(217) 235-5900

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1509667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1285146852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70887",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441900887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 CHARLESTON AVE E",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619386226",
            "telephone_number": "217-235-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILCO DENTAL GROUP LLC - MATTOON",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-03",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-235-5900"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Mattoon, IL
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• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.