Healthcare Provider Details

I. General information

NPI: 1427976687
Provider Name (Legal Business Name): CORNERSTONE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 GALEN DR STE 103
CHAMPAIGN IL
61821-7049
US

IV. Provider business mailing address

2502 GALEN DR STE 103
CHAMPAIGN IL
61821-7049
US

V. Phone/Fax

Practice location:
  • Phone: 217-280-8793
  • Fax:
Mailing address:
  • Phone: 217-280-8793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAE UNG JUNG
Title or Position: DOCTOR/MEMBER
Credential:
Phone: 217-480-2025