ILLINI SMILES DENTAL CARE PC (NPI# 1205245693) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205245693 |
| Entity Type | Organization |
| Organization Name | ILLINI SMILES DENTAL CARE PC |
| Practice Address |
201 W Springfield Ave Ste 506 Champaign IL 61820-6383 |
| Mailing Address |
701 Devonshire Dr D-1 Champaign IL 61820-7337 |
| Practice Telephone | 2173563335 |
| Mailing Telephone | 2173563335 |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2020-07-27 |
| Authorized Official Name | YUDONG XU (PRESIDENT) |
| Authorized Official Telephone | 2173563335 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
019026810 | IL | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891245957 | Illini Smiles Dental Care PC | Dentist | 303 W Springfield Ave, Champaign, IL 61820-4817 | 2016-10-12 |
| 1568841344 | Illini Smiles Dental Care PC | Dentist | 125 W Main St, Urbana, IL 61801-2714 | 2015-05-26 |
| Street Address |
201 W SPRINGFIELD AVE STE 506 |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61820-6383 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982217345 | Costco Wholesale Corporation | Pharmacy | 2002 N. Neil St., Champaign, IL 61820 | 2020-08-26 |
| 1255963583 | Jamey Richard Bailey | Social Worker | 701 Devonshire Drive, Bldg C, Suite 206, C-6, Champaign, IL 61820 | 2020-02-05 |
| 1790247443 | Jason Abrams | Counselor | 201 W Springfield Ave., Suite 1002-1003, Champaign, IL 61820 | 2019-04-02 |
| 1184100273 | Janine Rafferty | Pharmacist | 2002 N Neil St, Champaign, IL 61820 | 2018-07-12 |
| 1417475070 | Brodbeck Counseling, PC | Community/Behavioral Health | 301 N. Neil Street Suite 323, Champaign, IL 61820 | 2017-09-05 |
| 1447773726 | Quanata M Pelmore | Nurse's Aide | 508 E. Vine St, Champaign, IL 61820 | 2017-07-19 |
| 1821518127 | Molly Mclay | Social Worker | 309 W Clark St., Champaign, IL 61820 | 2017-06-27 |
| 1396265849 | Lou Echols Chambers | Audiologist | 901 South Sixth Street, Chamapign, IL 61820 | 2017-06-26 |
| 1962874495 | Luciana Angelica Guardini | Social Worker | 100 North Chestnut Street, Suite 244, Champaign, IL 61820 | 2015-10-23 |
| 1538544465 | Cpo Services, Inc. | Prosthetic/Orthotic Supplier | 410 E University Ave Ste 105, Champaign, IL 61820 | 2015-07-21 |
| Find all providers in zip 61820 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295268019 | Mountain Bay Dental LLC | Dentist | 3510 Marianna Dr, Champaign, IL 61822-9502 | 2017-04-08 |
| 1982094462 | Familia Dental Champaign LLC | Dentist | 1907 W Spfld Ave, Champaign, IL 61821-3067 | 2015-02-04 |
| 1306152806 | Tania G Lodhi | Dentist | 1902 N Prospect Ave, Suite 1, Champaign, IL 61822-1411 | 2010-08-23 |
| 1154651628 | Michael R Ruffatto | Dentist | 1202 Harrington Dr, Champaign, IL 61821-6514 | 2010-01-06 |
| 1407005879 | Promise Healthcare Nfp | Dentist | 819 Bloomington Road, Champaign, IL 61820 | 2008-09-10 |
| 1851540330 | Central Illinois Oral and Maxiofacial Surgery, PC | Dentist | 14 E Anthony Dr Ste C, Champaign, IL 61820-2749 | 2008-09-09 |
| 1407002165 | Nikkole Patterson | Dentist | 3101 Village Office Pl, Champaign, IL 61822-7673 | 2008-08-13 |
| 1407010176 | Douglas M Wallen | Dentist | 2502 Galen Dr, Suite 103, Champaign, IL 61821-7045 | 2008-07-11 |
| 1275703175 | Thomas E. Standley, Dmd, PC | Dentist | 30 E Green St, Suite 1, Champaign, IL 61820-7905 | 2008-03-06 |
| 1316149867 | Dental Professionals of Illinois, P.C. | Dentist | 314 W Kirby Ave, Champaign, IL 61820-7208 | 2007-06-05 |
| Find all providers in CHAMPAIGN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.