NPIMap

Organization Active NPI

Children'S Center for Dentistry

  • Pediatric Dentistry
  • Normal, IL
National Provider Identifier
1932709433
Registry record updated Apr 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
CHILDREN'S CENTER FOR DENTISTRY
Practice address
314 Susan Dr
Normal, IL 61761-6206
Phone
(309) 827-5437
Fax
(309) 265-0288
NPI assigned
Oct 26, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2021

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

Authorized official

Name
Mrs. Mackenzie Starkey
Title
Office Manager
Phone
(309) 827-5437

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

314 Susan Dr
Normal, IL 61761-6206

Mailing address

314 Susan Dr
Normal, IL 61761-6206
Phone (309) 827-5437

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL Desktop

National Provider Directory

National Provider Directory
Tax ID family
Children'S Center for Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

314 Susan Dr
Normal, IL 61761
Phone (309) 827-5437

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": "1603670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618790400000",
    "number": "1932709433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 SUSAN DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616206",
            "telephone_number": "309-827-5437",
            "fax_number": "309-265-0288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 SUSAN DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616206",
            "telephone_number": "309-827-5437",
            "fax_number": "309-265-0288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S CENTER FOR DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-26",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A",
        "authorized_official_last_name": "STARKEY",
        "authorized_official_first_name": "MACKENZIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "309-827-5437",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "Desktop",
            "affiliation": "N",
            "address_1": "314 Susan Dr",
            "city": "Normal",
            "state": "IL",
            "country_code": "US",
            "postal_code": "617616206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; 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.