NPIMap

Organization Active NPI

McLean County Dental

  • General Practice Dentistry
  • Bloomington, IL
National Provider Identifier
1417216870
Registry record updated May 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019015656 Issued in IL
Legal business name
MCLEAN COUNTY DENTAL
Practice address
2103 E Washington St
Suite 1C
Bloomington, IL 61701-4310
Phone
(309) 662-8448
Fax
(309) 662-7617
NPI assigned
May 4, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2012

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

Authorized official

Name
Dr. Emil M. Verban Jr., DDS
Title
Owner
Phone
(309) 662-8448

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019015656 IL Primary

Addresses

Primary practice location

2103 E Washington St
Suite 1C
Bloomington, IL 61701-4310

Mailing address

2103 E Washington St
Suite 1C
Bloomington, IL 61701-4310
Phone (309) 662-8448

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1336089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336089600000",
    "number": "1417216870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 E WASHINGTON ST",
            "address_2": "SUITE 1C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617014310",
            "telephone_number": "309-662-8448",
            "fax_number": "309-662-7617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 E WASHINGTON ST",
            "address_2": "SUITE 1C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617014310",
            "telephone_number": "309-662-8448",
            "fax_number": "309-662-7617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEAN COUNTY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-04",
        "last_updated": "2012-05-04",
        "status": "A",
        "authorized_official_last_name": "VERBAN",
        "authorized_official_first_name": "EMIL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-662-8448",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019015656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.