Maria Gabriela Rodriguez Mantilla, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019035401 Issued in IL

Practice address

232 E Knoxville St
Brimfield, IL 61517-8178

Phone

(309) 320-8750

NPI assigned

Jul 24, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brimfield Family Dentistry, P.C.

  • Dental Clinic/Center
  • Brimfield, IL
  • NPI 1568072668
  NPD

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

{
    "created_epoch": "1721779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1780412353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1362 CASTLE CREEK CIR",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801042253",
            "telephone_number": "720-308-6726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 E KNOXVILLE ST",
            "city": "BRIMFIELD",
            "state": "IL",
            "postal_code": "615178178",
            "telephone_number": "309-320-8750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ MANTILLA",
        "first_name": "MARIA",
        "middle_name": "GABRIELA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-24",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019035401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Randy Eugene Lloyd, LMT
• Clint Martin, D.M.D
• Marcia Mattern, CD (DONA)
• Susan Mayo
• Sarah Lynn Moon, M.A., CCC-SLP
• Curtis Bruce Sherman, RPH
• Sherman'S Pharmacy Co.
• Shine Therapy Services LLC
• Laura Sollenberger, MA
• St. Mary Medical Center

• Dentist in Brimfield, IL
• Providers in Brimfield, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.