Decatur 2012 LLC

Decatur 2012 LLC is a healthcare organization registered as Dental Clinic/Center in Decatur, IL, holding Type 2 (organization) NPI 1306107578 since 2012. The authorized official on file is Brandon Taylor, Credentialing Payer Relations Mgr.

✓ Active NPI ✓ Valid NPI checksum

NPI	1306107578
Entity type	Organization (Type 2)
Legal business name	Decatur 2012 LLC
Other name	<Unavail>
Practice address	141 E PERSHING RD, Decatur, IL, 62526
Phone	8889884066
Fax	8474967603
Enumeration date	2012-06-05
Last updated in NPPES	2021-10-15

Authorized official

Name	Brandon Taylor
Title	Credentialing Payer Relations Mgr
Phone	8474537396

Taxonomy & classification

Taxonomy code	Specialty	Primary	License	State
261QD0000X	Dental Clinic/Center	Primary	—	—

Copy-ready billing details

Provider: Decatur 2012 LLC
NPI: 1306107578
Taxonomy: 261QD0000X (Dental Clinic/Center)
Address: 141 E PERSHING RD, Decatur, IL, 62526

Providers at this address

NPI	Name	Type	Specialty	Location
1508127135	Kyoung Yun Lee	Individual	Dentist	Decatur, IL
1568725943	Decatur 2013 LLC	Organization	General Practice Dentistry	Decatur, IL
1003179482	Decatur 2014	Organization	General Practice Dentistry	Decatur, IL
1417210857	Decatur 2015 LLC	Organization	General Practice Dentistry	Decatur, IL
1154758712	Youngtak Chi	Individual	General Practice Dentistry	Decatur, IL
1891276341	Elizabeth Moore	Individual	Dentist	Decatur, IL
1669218798	Issa Sahouri	Individual	Dentist	Decatur, IL

Verify this record

Cross-check NPI 1306107578 against the authoritative CMS record: view Decatur 2012 LLC on the official NPPES registry .

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.

Frequently asked questions

Where is Decatur 2012 LLC located?

The practice location on file with NPPES is in Decatur, IL.

How current is this record?

Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2021-10-15. Verify at npiregistry.cms.hhs.gov.

Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2021-10-15.