MOUNTAIN BAY DENTAL LLC
NPI 1295268019
Dentist - General Practice in Champaign, IL

Q: What is Mountain Bay Dental LLC's NPI number?

The NPI number for Mountain Bay Dental LLC is 1295268019. It was assigned to this organization in the NPPES registry on April 8, 2017.

Q: What is Mountain Bay Dental LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Active since April 08, 2017

3510 MARIANNA DR, CHAMPAIGN, IL 61822(715) 496-1128 Get Directions Write a Review

NPPES record last updated: April 8, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Mountain Bay Dental Llc NPPES

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

MOUNTAIN BAY DENTAL LLC (NPI 1295268019) is a healthcare organization registered as a general practice in Champaign, Illinois and active in the NPI registry since April 2017. The organization lists Lanae W Johnson, Manager, as its authorized official.

NPPES Registry Identity

NPI1295268019

Entity TypeOrganization

Primary Taxonomy1223G0001X

Legal Business NameMOUNTAIN BAY DENTAL LLC

Location Address3510 MARIANNA DRChampaign, IL 61822-9502

Mailing Address5702 Memorial CtWeston, WI 54476-6502 · (715) 496-1128 · Fax (715) 972-8123

Phone(715) 496-1128

Organization SubpartNo

Authorized OfficialLanae W JohnsonManager · (715) 496-1128

Enumeration DateApril 8, 2017

✔ NPI 1295268019 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in WI · 1001483

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

3510 MARIANNA DR, 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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

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 Mountain Bay Dental LLC's NPI number?

The NPI number for Mountain Bay Dental LLC is 1295268019. It was assigned to this organization in the NPPES registry on April 8, 2017.

Where is Mountain Bay Dental LLC located?

Mountain Bay Dental LLC is located at 3510 Marianna Dr, Champaign, IL 61822. The listed phone number is (715) 496-1128.

What is Mountain Bay Dental LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

What insurance does Mountain Bay Dental LLC accept?

Health plans from UnitedHealthcare list Mountain Bay Dental LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mountain Bay Dental LLC was last updated on April 8, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.