AFFILIATES IN ORAL & MAXILLOFACIAL SURGERY LTD
NPI 1215196290
Dentist - Oral and Maxillofacial Surgery in Champaign, IL

Q: What is Affiliates In Oral & Maxillofacial Surgery Ltd's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Active since June 05, 2008

3112 VILLAGE OFFICE PL, CHAMPAIGN, IL 61822(217) 351-7111(217) 351-7282 Get Directions Write a Review

NPPES record last updated: June 5, 2008. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About Affiliates In Oral & Maxillofacial Surgery Ltd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AFFILIATES IN ORAL & MAXILLOFACIAL SURGERY LTD (NPI 1215196290) is a healthcare organization registered as an oral and maxillofacial surgery in Champaign, Illinois and active in the NPI registry since June 2008. The organization lists Philip R. Banghart, President/oral Surgeon, as its authorized official.

NPPES Registry Identity

NPI1215196290

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameAFFILIATES IN ORAL & MAXILLOFACIAL SURGERY LTD

Location Address3112 VILLAGE OFFICE PLChampaign, IL 61822-7680

Mailing Address3112 Village Office PlChampaign, IL 61822-7680 · (217) 351-7111 · Fax (217) 351-7282

Phone(217) 351-7111

Fax(217) 351-7282

Organization SubpartNo

Authorized OfficialPhilip R. BanghartPresident/oral Surgeon · (217) 351-7111

Enumeration DateJune 5, 2008

✔ NPI 1215196290 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in IL · 019021176

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

3112 VILLAGE OFFICE PL, Champaign, IL 61822

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Affiliates In Oral & Maxillofacial Surgery Ltd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 2 clinicians reassign Medicare billing to Affiliates In Oral & Maxillofacial Surgery Ltd, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Theron Waisath, DMD

Maxillofacial Surgery

NPI 1144423963

3112 VILLAGE OFFICE PL
Champaign, IL 61822

(217) 351-7111

✔ PECOS✔ Accepts MedicareSame address

Philip Banghart, D.D.S.

Maxillofacial Surgery

NPI 1982609087

102 PROFESSIONAL PLZ
Mattoon, IL 61938

(217) 345-7070

✔ PECOS✔ Accepts Medicare41 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Affiliates In Oral & Maxillofacial Surgery Ltd's NPI number?

The NPI number for Affiliates In Oral & Maxillofacial Surgery Ltd is 1215196290. It was assigned to this organization in the NPPES registry on June 5, 2008.

Where is Affiliates In Oral & Maxillofacial Surgery Ltd located?

Affiliates In Oral & Maxillofacial Surgery Ltd is located at 3112 Village Office Pl, Champaign, IL 61822. The listed phone number is (217) 351-7111.

What is Affiliates In Oral & Maxillofacial Surgery Ltd's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Affiliates In Oral & Maxillofacial Surgery Ltd enrolled in Medicare?

Yes. Affiliates In Oral & Maxillofacial Surgery Ltd is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Affiliates In Oral & Maxillofacial Surgery Ltd?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Maxillofacial Surgery, reassign their Medicare billing to Affiliates In Oral & Maxillofacial Surgery Ltd. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Affiliates In Oral & Maxillofacial Surgery Ltd was last updated on June 5, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.