NPIMap

Organization Active NPI

Illini Smiles Dental Care P.C.

Doing business as Angel Smiles Dental Center

  • General Practice Dentistry
  • Rantoul, IL
National Provider Identifier
1417208455
Registry record updated Oct 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019026810 Issued in IL
Legal business name
ILLINI SMILES DENTAL CARE P.C.
Doing business as
Angel Smiles Dental Center
Practice address
730 Enterprise
Rantoul, IL 61866-3689
Phone
(217) 364-7235
NPI assigned
Oct 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2012

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

Authorized official

Name
Dr. Yudong Xu, DMD
Title
President
Phone
(217) 364-7235

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019026810 IL Primary

Addresses

Primary practice location

730 Enterprise
Rantoul, IL 61866-3689

Mailing address

2803 Cherry Hills Dr
Champaign, IL 61822-7541

Other names 1

  • Angel Smiles Dental Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Illini Smiles Dental Care PC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

730 Enterprise
Rantoul, IL 61866
Phone (217) 359-9900

NPI Registry JSON

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349049600000",
    "number": "1417208455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2803 CHERRY HILLS DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618227541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 ENTERPRISE",
            "city": "RANTOUL",
            "state": "IL",
            "postal_code": "618663689",
            "telephone_number": "217-364-7235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINI SMILES DENTAL CARE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-01",
        "last_updated": "2012-10-01",
        "status": "A",
        "authorized_official_last_name": "XU",
        "authorized_official_first_name": "YUDONG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-364-7235",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Angel Smiles Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rantoul, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; 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.