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General NPI Number Information
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NPI Number | 1366698656
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Entity Type | Organization
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Legal Business Name | IMPROVING SMILES LTD
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 2102 N MARKET ST
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City | CHAMPAIGN
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State | IL
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Zip | 61822-1306
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Country | US
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Telephone | 217-351-2667
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Fax | 217-351-2668
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Provider Business Mailing Address
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Address Line | 2102 N MARKET ST
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City | CHAMPAIGN
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State | IL
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Zip | 61822-1306
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Country | US
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Telephone | 217-351-2667
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Fax | 217-351-2668
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. TODD A. JOHNSON
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Credential | D.M.D.
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Telephone | 217-351-2667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 019025511
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License Number State | IL
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