NPIMap

Organization Active NPI

Southland Smiles, LTD

  • Dentist
  • Flossmoor, IL
National Provider Identifier
1336288695
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SOUTHLAND SMILES, LTD
Practice address
19815 Governors Hwy
Suite 7
Flossmoor, IL 60422-4385
Phone
(708) 799-7800
Fax
(708) 799-4864
NPI assigned
Feb 5, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Richard J Mantoan, DDSNPI 1740283605
Title
Owner
Phone
(708) 799-7800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X IL Primary

Addresses

Primary practice location

19815 Governors Hwy
Suite 7
Flossmoor, IL 60422-4385

Mailing address

19815 Governors Hwy
Suite 7
Flossmoor, IL 60422-4385
Phone (708) 799-7800

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336288695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19815 GOVERNORS HWY",
            "address_2": "SUITE 7",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604224385",
            "telephone_number": "708-799-7800",
            "fax_number": "708-799-4864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19815 GOVERNORS HWY",
            "address_2": "SUITE 7",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604224385",
            "telephone_number": "708-799-7800",
            "fax_number": "708-799-4864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND SMILES, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANTOAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-799-7800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flossmoor, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.