NPIMap

Organization Active NPI

Dental Professionals of Illinois, P.C.

Doing business as Smile For Life Dentistry

  • General Practice Dentistry
  • Maryville, IL
National Provider Identifier
1326260647
Registry record updated Jan 8, 2014
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
Smile For Life Dentistry
Practice address
4971 S. State Rte 159
Maryville, IL 62062
Phone
(618) 288-6699
Fax
(618) 288-8977
NPI assigned
May 3, 2007
Last updated
Jan 8, 2014By 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 Jan 8, 2014

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

Authorized official

Name
Lindsay Bearden
Title
Ins Cood
Phone
(217) 540-5100

Specialties & licenses 1

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

Addresses

Primary practice location

4971 S. State Rte 159
Maryville, IL 62062

Mailing address

4971 S. State Rte 159
Maryville, IL 62062
Phone (618) 288-6699

Other names 1

  • Smile For Life Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Family Dental Care of Illinois PC75 organizations share this tax ID, including this one
Part of
Heartland Family Dental Care 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

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389139200000",
    "number": "1326260647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4971 S. STATE RTE 159",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "62062",
            "telephone_number": "618-288-6699",
            "fax_number": "618-288-8977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4971 S. STATE RTE 159",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "62062",
            "telephone_number": "618-288-6699",
            "fax_number": "618-288-8977"
        }
    ],
    "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": "2007-05-03",
        "last_updated": "2014-01-08",
        "status": "A",
        "authorized_official_last_name": "BEARDEN",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_title_or_position": "INS COOD",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile For Life Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maryville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; 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.