Organization
ILLINI SMILES DENTAL CARE PC
Active
Parent organization
ILLINI SMILES DENTAL CARE PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ILLINI SMILES DENTAL CARE PC
Authorized official
YUDONG XU (ONWER)
(217) 356-3335
Entity
Organization
Contact information
Practice address
303 W SPRINGFIELD AVE, CHAMPAIGN, IL 61820-4817
(217) 356-3335
Mailing address
303 W SPRINGFIELD AVE, CHAMPAIGN, IL 61820-4817
(217) 356-3335
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019026810
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9178971
—
IL
Enumeration date
10/12/2016
Last updated
10/12/2016
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