NPIMap

Organization Active NPI

Beautiful Smiles Mobile Dentistry, LLC

  • Preferred Provider Organization
  • Champaign, IL
National Provider Identifier
1386035467
Registry record updated Feb 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
019029681 Issued in IL
Legal business name
BEAUTIFUL SMILES MOBILE DENTISTRY, LLC
Practice address
2547 W Springfield Ave
Apt 2
Champaign, IL 61821-2820
Phone
(217) 552-8503
NPI assigned
Feb 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2015

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

Authorized official

Name
Leonor Cecilia Villalta, DDSNPI 1700034089
Title
Managing Dentist
Phone
(217) 722-4565

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
Preferred Provider Organization 305R00000X 019029681 IL Primary

Addresses

Primary practice location

2547 W Springfield Ave
Apt 2
Champaign, IL 61821-2820

Mailing address

2547 W Springfield Ave
Apt 2
Champaign, IL 61821-2820
Phone (217) 552-8503

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.

NPI Registry JSON

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

{
    "created_epoch": "1423612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423612800000",
    "number": "1386035467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2547 W SPRINGFIELD AVE",
            "address_2": "APT 2",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618212820",
            "telephone_number": "217-552-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2547 W SPRINGFIELD AVE",
            "address_2": "APT 2",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618212820",
            "telephone_number": "217-552-8503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUTIFUL SMILES MOBILE DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-11",
        "last_updated": "2015-02-11",
        "status": "A",
        "authorized_official_last_name": "VILLALTA",
        "authorized_official_first_name": "LEONOR",
        "authorized_official_middle_name": "CECILIA",
        "authorized_official_title_or_position": "MANAGING DENTIST",
        "authorized_official_telephone_number": "217-722-4565",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "019029681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

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