# CENTRAL ILLINOIS ORAL AND MAXILLOFACIAL SURGERY, PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTRAL ILLINOIS ORAL AND MAXILLOFACIAL SURGERY, PC
- **Other names:** Champaign Oral Surgery Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1669540399
- **Legal business name:** CENTRAL ILLINOIS ORAL AND MAXILLOFACIAL SURGERY, PC
- **Authorized official:** AMY M KROEGER (INSURANCE COORDINATOR)
- **Authorized official phone:** (217) 540-5100

## Contact information

- **Practice address:** 14 E ANTHONY DR, SUITE C, CHAMPAIGN, IL 61820-2748
- **Practice address phone:** (217) 355-2809
- **Practice address fax:** (217) 355-5921
- **Mailing address:** 14 E ANTHONY DR, SUITE C, CHAMPAIGN, IL 61820-2748
- **Mailing address phone:** (217) 355-2809
- **Mailing address fax:** (217) 355-5921

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 12/01/2006
- **Last updated:** 08/23/2023