DENTAL PROFESSIONALS OF ILLINOIS, P.C. (NPI# 1013139609) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013139609 |
| Entity Type | Organization |
| Organization Name | DENTAL PROFESSIONALS OF ILLINOIS, P.C. |
| Other Organization Name | MYCHARLESTONDENTIST.COM |
| Practice Address |
826 W Lincoln Avenue Suite A Charleston IL 61920 |
| Practice Telephone | 2173451315 |
| Practice Fax Number | 2173451291 |
| Mailing Telephone | 2173451315 |
| Mailing Fax Number | 2173451291 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2014-01-07 |
| Authorized Official Name | LINDSAY BEARDEN (INS COOD) |
| Authorized Official Telephone | 2175405100 |
| Is Organization Subpart | Y |
| Parent Organization Name | DENTAL PROFESSIONALS OF ILLINOIS, P.C. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Mycharlestondentist.com | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669092177 | Dental Professionals of Illinois, P.C. | Dentist | 3419 Orchard Rd, Oswego, IL 60543-5005 | 2020-04-24 |
| 1790262434 | Dental Professionals of Illinois, P.C. | Dentist | 1402 S Us Highway 12, Fox Lake, IL 60020-1252 | 2018-07-25 |
| 1255884623 | Dental Professionals of Illinois, P.C. | Dentist | 2740 Prairie Crossing Drive, Springfield, IL 62711 | 2016-08-02 |
| 1043609167 | Dental Professionals of Illinois, P.C. | Dentist | 9990 W 190th St, Suite D, Mokena, IL 60448-8188 | 2015-01-13 |
| 1144623273 | Dental Professionals of Illinois, P.C. | Dentist | 540 W Walnut St, Oglesby, IL 61348-1400 | 2014-10-03 |
| 1053713966 | Dental Professionals of Illinois, P.C. | Dentist | 1411 W Lane Rd Ste B, Machesney Park, IL 61115 | 2014-09-23 |
| 1346651577 | Dental Professionals of Illinois, P.C. | Dentist | 1490 Douglas Rd, Oswego, IL 60543-5106 | 2014-05-09 |
| 1972925584 | Dental Professionals of Illinois, P.C. | Dentist | 6631 Grand Ave Ste 1, Gurnee, IL 60031-5284 | 2014-01-16 |
| 1386985380 | Dental Professionals of Illinois, P.C. | Dentist | 368 W. Washington St., East Peoria, IL 61611 | 2013-03-15 |
| 1871842112 | Dental Professionals of Illinois, P.C. | Dentist | 12605 Troxler Ave, Highland, IL 62249 | 2012-08-31 |
| Street Address |
826 W LINCOLN AVENUE SUITE A |
| City | CHARLESTON |
| State | IL |
| Zip Code | 61920 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124643879 | Jenna Kay Mortensen | Speech-Language Pathologist | 2086 7th Street, Charleston, IL 61920 | 2020-06-09 |
| 1255954566 | Christina L. White | Nurse Practitioner | 1199 Persimmon Rd, Charleston, IL 61920 | 2020-05-20 |
| 1679066773 | Jennifer Hess | Specialist/Technologist | 2506 Lantz Building, Charleston, IL 61920 | 2018-06-13 |
| 1134647969 | Nichole C Ogilvie | Student in an Organized Health Care Education/Training Program | 917 4th Street Apt 19, Charleston, IL 61920 | 2017-08-31 |
| 1467970319 | Marcus Roach | Physical Therapy Assistant | 912 Oakcrest Dr. Apt D, Charleston, IL 61920 | 2017-08-30 |
| 1114478500 | 5 Guys Rx II LLC | Pharmacy | 1 W Lincoln Ave, Charleston, IL 61920 | 2016-10-20 |
| 1649723206 | Bright Minds Educational Program Inc | Developmental Therapist | 7704 Deerpath Road, Charleston, IL 61920 | 2016-08-01 |
| 1760843379 | Lisa Price | Nurse Practitioner | 2040 Lincoln Ave, Suite 100, Charleston, IL 61920 | 2016-03-09 |
| 1104243385 | Nathan David Schwartzkopf | Specialist/Technologist | 1340 A Street, Charleston, IL 61920 | 2014-03-25 |
| 1558694349 | Emily Schilling | Specialist/Technologist | 2350 Harrison Avenue, Charelston, IL 61920 | 2009-09-10 |
| Find all providers in zip 61920 | ||||
| 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 |
|---|---|---|---|---|
| 1265039754 | Ravi Bhupen Patel | Dentist | 1755 Central Park Rd, Unit 1107, Charleston, SC 29412-2846 | 2020-10-07 |
| 1598372864 | Dental Professional of South Carolina, P.C. | Dentist | 1417 Folly Rd Ste 402, Charleston, SC 29412-9737 | 2020-09-30 |
| 1023627619 | Dental Professional of South Carolina, P.C. | Dentist | 702 Hopewell Dr, Charleston, SC 29492-7102 | 2020-07-29 |
| 1427673946 | Leslie Jordan Mcgarity | Dentist | 29 Bee Street Dc 271 Msc 507, Charleston, SC 29425-0001 | 2020-06-10 |
| 1629691449 | Tgd-west Ashley LLC | Dentist | 2048 Sam Rittenberg Blvd Ste 2, Charleston, SC 29407-4673 | 2020-05-27 |
| 1922650647 | Kinnara Vasamsetti Emmons | Dentist | 46 Queen St Apt B, Charleston, SC 29401-2805 | 2019-07-12 |
| 1932769189 | John Fitzgerald | Dentist | 26 Bee Street Msc 507 Dental Clinic Room 550, Charleston, SC 29425-0001 | 2019-06-19 |
| 1144880808 | Miranda Jo Ferrari | Dentist | 3 Creekstone Rdg, Charleston, WV 25309-8986 | 2019-06-15 |
| 1114586054 | Charleston Dental Associates, LLC | Dentist | 915 Saint Andrews Blvd, Charleston, SC 29407-7138 | 2019-06-12 |
| 1285123471 | Burgess Dental | Dentist | 405 Capitol Street, The Parlor Suite, Charleston, WV 25301 | 2018-05-03 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 61920 |
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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.