Healthcare Provider Details

I. General information

NPI: 1871415877
Provider Name (Legal Business Name): SMALLTOWN DENTAL SPRINGFIELD WEST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 GREENBRIAR DR STE C
SPRINGFIELD IL
62704-7433
US

IV. Provider business mailing address

1600 S 4TH AVE STE 110
MORTON IL
61550-3401
US

V. Phone/Fax

Practice location:
  • Phone: 217-787-3727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: LUKE OVERCASH
Title or Position: CIO
Credential:
Phone: 309-370-5853