NPIMap

Organization Active NPI

Pediatric Dental Associates of McLean County, Inc

  • Dental Clinic/Center
  • Bloomington, IL
National Provider Identifier
1982878708
Registry record updated Apr 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PEDIATRIC DENTAL ASSOCIATES OF MCLEAN COUNTY, INC
Practice address
211 S Prospect Rd
Bloomington, IL 61704-4910
Phone
(309) 663-7339
Fax
(309) 663-7131
NPI assigned
Apr 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2008

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

Authorized official

Name
Dr. Sara R Rauen Dardis, D.D.S., M.S.NPI 1558465583
Title
Pediatric Dentist
Phone
(309) 663-7339

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X IL Primary
Dental Clinic/Center 261QD0000X IL

Addresses

Primary practice location

211 S Prospect Rd
Bloomington, IL 61704-4910

Mailing address

211 S Prospect Rd
Bloomington, IL 61704-4910
Phone (309) 663-7339

National Provider Directory

National Provider Directory

Locations

211 S Prospect Rd
Bloomington, IL 61704
Phone (309) 663-7339

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": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208131200000",
    "number": "1982878708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 S PROSPECT RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617044910",
            "telephone_number": "309-663-7339",
            "fax_number": "309-663-7131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S PROSPECT RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617044910",
            "telephone_number": "309-663-7339",
            "fax_number": "309-663-7131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL ASSOCIATES OF MCLEAN COUNTY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2008-04-14",
        "status": "A",
        "authorized_official_last_name": "RAUEN DARDIS",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "309-663-7339",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2008; 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.