Smalltown Dental Kids LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

SMALLTOWN DENTAL KIDS LLC

Practice address

1600 S 4TH Ave Ste 120
Morton, IL 61550-3401

Phone

(309) 263-2781

NPI assigned

Feb 18, 2021

Organization subpart

Yes

Parent organization

SMALLTOWN DENTAL MANAGEMENT LLCAs reported in NPPES

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

Authorized official

Name

Luke Overcash

Title

Operations Manager

Phone

(309) 370-5853

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1407449762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S 4TH AVE STE 120",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615503401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S 4TH AVE STE 120",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615503401",
            "telephone_number": "309-263-2781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMALLTOWN DENTAL KIDS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SMALLTOWN DENTAL MANAGEMENT LLC",
        "enumeration_date": "2021-02-18",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A",
        "authorized_official_last_name": "OVERCASH",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "309-370-5853"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Signature Anesthesia LLC
• Michele Simmons, MS
• Gregory J Skibinski, LCPC
• David M Skillrud, MD
• Mackenzie Lynn Smalley, LCSW
• Smalltown Dental Morton LLC
• Smalltown Dental on Fourth LLC
• Jennifer Smidt
• Peter Smidt, DDS
• Amanda Smith, IBCLC

• Pediatric Dentistry in Morton, IL
• Providers in Morton, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; 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.