Healthcare Provider Details

I. General information

NPI: 1306763511
Provider Name (Legal Business Name): DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NETWORK CENTRE DR STE 1B
EFFINGHAM IL
62401-4637
US

IV. Provider business mailing address

1200 NETWORK CENTRE DR STE 1B
EFFINGHAM IL
62401-4637
US

V. Phone/Fax

Practice location:
  • Phone: 217-500-5250
  • Fax: 217-500-5255
Mailing address:
  • Phone: 217-500-5250
  • Fax: 217-500-5255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: HILLARY THULL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-540-8946