NPIMap

Organization Active NPI

Illini Smiles Dental Care PC

  • General Practice Dentistry
  • Champaign, IL
National Provider Identifier
1891245957
Registry record updated Oct 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019026810 Issued in IL
Legal business name
ILLINI SMILES DENTAL CARE PC
Practice address
303 W Springfield Ave
Champaign, IL 61820-4817
Phone
(217) 356-3335
NPI assigned
Oct 12, 2016
Organization subpart
Yes
Parent organization
ILLINI SMILES DENTAL CARE PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 12, 2016

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

Authorized official

Name
Yudong Xu
Title
Onwer
Phone
(217) 356-3335

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019026810 IL Primary

Addresses

Primary practice location

303 W Springfield Ave
Champaign, IL 61820-4817

Mailing address

303 W Springfield Ave
Champaign, IL 61820-4817
Phone (217) 356-3335

Other identifiers 1

IdentifierTypeStateIssuer
9178971MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Illini Smiles Dental Care PC9 organizations share this tax ID, including this one
Part of
Illini Smiles Dental Care PC

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

303 W Springfield Ave
Champaign, IL 61820
Phone (217) 356-3335

NPI Registry JSON

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476230400000",
    "number": "1891245957",
    "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",
            "telephone_number": "217-356-3335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 W SPRINGFIELD AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618204817",
            "telephone_number": "217-356-3335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINI SMILES DENTAL CARE PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ILLINI SMILES DENTAL CARE PC",
        "enumeration_date": "2016-10-12",
        "last_updated": "2016-10-12",
        "status": "A",
        "authorized_official_last_name": "XU",
        "authorized_official_first_name": "YUDONG",
        "authorized_official_title_or_position": "ONWER",
        "authorized_official_telephone_number": "217-356-3335"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9178971",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; 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.