NPIMap

Organization Active NPI

Illini Smiles Dental Care P.C.

  • Dentist
  • Urbana, IL
National Provider Identifier
1417517426
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
ILLINI SMILES DENTAL CARE P.C.
Practice address
1812 Philo Rd
Urbana, IL 61802-6016
Phone
(217) 729-7411
NPI assigned
Jun 20, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Authorized official

Name
Yudong Xu
Title
Ceo
Phone
(217) 892-8868

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1812 Philo Rd
Urbana, IL 61802-6016

Mailing address

303 W Springfield Ave
Champaign, IL 61820-4817

Other names 1

  • Urbana Family Dental 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

1812 Philo Rd
Urbana, IL 61802
Phone (217) 729-7411

Practitioners & affiliated clinicians

Practitioners 2

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": "1560988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560988800000",
    "number": "1417517426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 W SPRINGFIELD AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618204817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 PHILO RD",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618026016",
            "telephone_number": "217-729-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINI SMILES DENTAL CARE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-20",
        "last_updated": "2019-06-20",
        "status": "A",
        "authorized_official_last_name": "XU",
        "authorized_official_first_name": "YUDONG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-892-8868"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urbana Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Urbana, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; 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.