Mohammed Nkutukirunda, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019028830 Issued in IL

Practice address

1905 Convenience PL
Suite B
Champaign, IL 61820-8926

Phone

(217) 356-7400

Fax

(217) 356-7405

NPI assigned

Aug 11, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dental Professionals of Illinois, P.C.

  • General Practice Dentistry
  • Champaign, IL
  • NPI 1619180973
  NPD (past)
• Lifetime Dental Care of Illinois, PC

  • General Practice Dentistry
  • Bloomington, IL
  • NPI 1265654412
  NPD (past)

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

{
    "created_epoch": "1313020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313020800000",
    "number": "1376822064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 CONVENIENCE PL",
            "address_2": "SUITE B",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618208926",
            "telephone_number": "217-356-7400",
            "fax_number": "217-356-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 CONVENIENCE PL",
            "address_2": "SUITE B",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618208926",
            "telephone_number": "217-356-7400",
            "fax_number": "217-356-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NKUTUKIRUNDA",
        "first_name": "MOHAMMED",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-11",
        "last_updated": "2011-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tommy Nguyen, BS
• Tanya Lynne Nielsen, D.D.S.
• Kenneth J. Nieman, D.C
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• Charlene Nix
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• Daniel Noice, LMT
• Meredith Ann Nolan, BCBA
• Darion Noles, RBT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; 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.