Healthcare Provider Details

I. General information

NPI: 1942883525
Provider Name (Legal Business Name): CU DENTISTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 WEST SPRINGFIELD AVE
CHAMPAIGN IL
61820
US

IV. Provider business mailing address

805 WEST SPRINGFIELD AVE
CHAMPAIGN IL
61820
US

V. Phone/Fax

Practice location:
  • Phone: 217-352-5088
  • Fax: 217-352-7751
Mailing address:
  • Phone: 217-352-5088
  • Fax: 217-352-7751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BENJAMIN SCOTT
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 217-352-5088