NPIMap

Organization Active NPI

Restoration Dental LLC - Charleston Family Dental

Doing business as Charleston Family Dental

  • General Practice Dentistry
  • Charleston, IL
National Provider Identifier
1780957092
Registry record updated Oct 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
RESTORATION DENTAL LLC - CHARLESTON FAMILY DENTAL
Doing business as
Charleston Family Dental
Practice address
903 18TH St
Charleston, IL 61920-2938
Phone
(217) 348-7770
Fax
(217) 348-9279
NPI assigned
Feb 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2015

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

Authorized official

Name
Jamie Vilk
Title
Operations Manager
Phone
(217) 348-7770

Specialties & licenses 1

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

Addresses

Primary practice location

903 18TH St
Charleston, IL 61920-2938

Mailing address

903 18TH St.
Charleston, IL 61920
Phone (217) 348-7770

Other names 1

  • Charleston Family Dental Doing business as

National Provider Directory

National Provider Directory

Locations

903 18th St
Charleston, IL 61920
Phone (217) 348-7770

NPI Registry JSON

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

{
    "created_epoch": "1329350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443657600000",
    "number": "1780957092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 18TH ST.",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "61920",
            "telephone_number": "217-348-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 18TH ST",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619202938",
            "telephone_number": "217-348-7770",
            "fax_number": "217-348-9279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATION DENTAL LLC - CHARLESTON FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-16",
        "last_updated": "2015-10-01",
        "status": "A",
        "authorized_official_last_name": "VILK",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "217-348-7770"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charleston Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2015; 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.