DECATUR 2015 LLC (NPI# 1417210857) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417210857 |
| Entity Type | Organization |
| Organization Name | DECATUR 2015 LLC |
| Practice Address |
141 E Pershing Rd Decatur IL 62526-3213 |
| Mailing Address |
2050 E Algonquin Rd Suite610 Schaumburg IL 60173-4144 |
| Practice Telephone | 8889884066 |
| Practice Fax Number | 8474967603 |
| Mailing Telephone | 8889884066 |
| Mailing Fax Number | 8474967603 |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2012-06-20 |
| Authorized Official Name | DR. KOUSHAN AZAD (PRESIDENT) |
| Authorized Official Telephone | 8889884066 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Street Address |
141 E PERSHING RD |
| City | DECATUR |
| State | IL |
| Zip Code | 62526-3213 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508127135 | Kyoung Yun Lee | Dentist | 141 E Pershing Rd, Decatur, IL 62526-3213 | 2012-05-30 |
| 1154932218 | Myoungsu Song | Dentist | 141 E Pershing Rd, Decatur, IL 62526-3213 | 2020-08-12 |
| 1972120913 | Hong Keun Yoon | Dentist | 141 E Pershing Rd, Decatur, IL 62526-3213 | 2020-06-25 |
| 1891276341 | Elizabeth Moore | Dentist | 141 E Pershing Rd, Decatur, IL 62526-3213 | 2018-08-23 |
| 1023561933 | Abhinav Kalra | Dentist | 141 E Pershing Rd, Decatur, IL 62526-3213 | 2016-07-27 |
| 1154758712 | Youngtak Chi | Dentist | 141 E Pershing Rd, Decatur, IL 62526-3213 | 2013-09-27 |
| 1568725943 | Decatur 2013 LLC | Dentist | 141 E Pershing Rd, Decatur, IL 62526-3213 | 2012-06-20 |
| 1003179482 | Decatur 2014 | Dentist | 141 E Pershing Rd, Suite 610, Decatur, IL 62526-3213 | 2012-06-20 |
| 1306107578 | Decatur 2012 LLC | Dentist | 141 E Pershing Rd, Decatur, IL 62526-3213 | 2012-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083100804 | Coalition | Non-emergency Medical Transport (VAN) | 2375 N Longwood Dr, Decatur, IL 62526 | 2018-07-04 |
| 1881116820 | Bria N Howard | Nurse's Aide | 606 E Warren St. Apt 609, Decatur, IL 62526 | 2017-07-12 |
| 1437683679 | Lutheran Child and Family Services | Foster Care Agency | 2826 N. Monroe Street, Decatur, IL 62526 | 2017-04-14 |
| 1083166326 | Whitney Miller | Pharmacist | 225 East Ash Ave, Decatur, IL 62526 | 2016-11-03 |
| 1487053369 | Central Illinois Health Associates, Inc | Preferred Provider Organization | 2300 N. Edward Street, Decatur, IL 62526 | 2014-08-18 |
| 1659787893 | Stephanie Marie Kanitsch | Obstetrics & Gynecology | 544 W Pershing Rd Ste A, Decatur, IL 62526 | 2014-07-09 |
| 1497169973 | Brian Hassinger | Audiologist-Hearing Aid Fitter | 2605 N Water St Ste 101, Decatur, IL 62526 | 2014-06-12 |
| 1891041570 | Decatur 2016 LLC | Dentist | 141 Epershing Rd, Decatur, IL 62526 | 2012-07-31 |
| 1558639005 | Larry Lee Christensen | Pharmacist | 225 Ash Ave, Decatur, IL 62526 | 2011-12-12 |
| 1174821540 | Nathan Pyle | Internal Medicine | 2 Memorial Dr Ste 101, Decatur, IL 62526 | 2011-03-08 |
| Find all providers in zip 62526 | ||||
| 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 |
|---|---|---|---|---|
| 1548870884 | Daniel Patrick Jurgens | Dentist | 2 N Country Club Rd Ste 2, Decatur, IL 62521-4174 | 2020-08-02 |
| 1134744576 | Dafna Lapidot | Dentist | 1074 Vistavia Cir, Decatur, GA 30033-3413 | 2020-06-11 |
| 1184140121 | Access Dental Care, LLC | Dentist | 1621 Wolverine Dr Se, Decatur, AL 35601-4933 | 2017-08-22 |
| 1154868917 | North Decatur Dentistry, PC | Dentist | 2570 Blackmon Drive, Suite 320, Decatur, GA 30033 | 2017-01-31 |
| 1245645084 | Mobile Dental Services of Alabama PC | Dentist | 3231 Fieldstone Dr Sw, Decatur, AL 35603-3173 | 2014-06-30 |
| 1619317518 | Jieun Jun | Dentist | 2450 Lawrenceville Hwy Ste 100, Decatur, GA 30033-3269 | 2013-06-25 |
| 1366794711 | Complete Dental Decatur LLC | Dentist | 1241 Point Mallard Parkway, Suite. 105, Decatur, AL 35601 | 2012-10-10 |
| 1891041570 | Decatur 2016 LLC | Dentist | 141 Epershing Rd, Decatur, IL 62526 | 2012-07-31 |
| 1467731679 | David Gatti Corless | Dentist | 301 W. Main St., Decatur, TX 76234 | 2011-08-05 |
| 1598092801 | Brandon Michael Piper | Dentist | 469 W Wood St, Decatur, IL 62522-3109 | 2009-11-06 |
| Find all providers in DECATUR | ||||
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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.