NPIMap

Organization Active NPI

Illini Smiles Dental Care P.C.

  • General Practice Dentistry
  • Mahomet, IL
National Provider Identifier
1457227605
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ILLINI SMILES DENTAL CARE P.C.
Practice address
200 Eastwood Dr
Mahomet, IL 61853-7035
Phone
(217) 586-5667
NPI assigned
Oct 15, 2025
Last updated
Oct 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

200 Eastwood Dr
Mahomet, IL 61853-7035

Mailing address

200 Eastwood Dr
Mahomet, IL 61853-7035
Phone (217) 586-5667

Other practice location 1

109 N Chestnut St Ste 4
Onarga, IL 60955-1255
Phone (815) 268-0033

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

109 N Chestnut St
Ste 4
Onarga, IL 60955
Phone (815) 268-0033

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1760486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760486400000",
    "number": "1457227605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 EASTWOOD DR",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618537035",
            "telephone_number": "217-586-5667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 EASTWOOD DR",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618537035",
            "telephone_number": "217-586-5667"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 N Chestnut St Ste 4",
            "address_purpose": "LOCATION",
            "city": "Onarga",
            "state": "IL",
            "postal_code": "609551255",
            "country_code": "US",
            "telephone_number": "815-268-0033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ILLINI SMILES DENTAL CARE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-15",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "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",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mahomet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2025; 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.