DR. JAI KRISHNA SRIKANTH KOLLIBOYANA (NPI# 1194379271) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194379271 |
| Entity Type | Individual |
| Full Name | DR. JAI KRISHNA SRIKANTH KOLLIBOYANA |
| Credential | DDS |
| Practice Address |
1200 W Main St Ste 9 Peoria IL 61606-1218 |
| Mailing Address |
1600 W Blue Sage Dr Apt 3315 Peoria IL 61615-7233 |
| Practice Telephone | 3097779777 |
| Mailing Telephone | 9894234811 |
| Enumeration Date | 2019-07-28 |
| Last Update Date | 2019-07-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 019.032253 | IL | Dental Providers |
| Street Address |
1200 W MAIN ST STE 9 |
| City | PEORIA |
| State | IL |
| Zip Code | 61606-1218 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962943290 | Optim Dental Peoria-1 LLC | Dentist | 1200 W Main St Ste 9, Peoria, IL 61606-1218 | 2017-03-20 |
| 1417475146 | Allen Jaywan Bai | Dentist | 1200 W Main St Ste 9, Peoria, IL 61606-1218 | 2017-09-01 |
| 1740704832 | Venkat Yashaswi Kondapalli | Dentist | 1200 W Main St Ste 9, Peoria, IL 61606-1218 | 2017-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194292334 | Kelley Stork | Speech-Language Pathologist | 807 W Columbia Terrace, Peoria, IL 61606 | 2018-10-25 |
| 1689140519 | Emma Cristine Tully | Speech-Language Pathologist | 1619 W. Fredonia Ave, Peoria, IL 61606 | 2018-10-18 |
| 1316492432 | Jennifer Greenwood | Nurse Practitioner | 1001 Main St Ste 500a, Peoria, IL 61606 | 2016-08-18 |
| 1104944974 | Robert I Martin | Preventive Medicine | 1127 N North Street, Peoria, IL 61606 | 2007-03-27 |
| 1023062312 | Saint Francis Medical Center | Physical Medicine & Rehabilitation | 100 Ne Randoph Street, Peoria, IL 61606 | 2006-05-20 |
| 1174573307 | Cpo Services, Inc | Prosthetic/Orthotic Supplier | 741 West Main Street, Peoria, IL 61606 | 2006-05-10 |
| 1174025357 | Amy M Durst | Nurse Practitioner | 1001 Main St Ste 500a, Peoria, IL 61606 | 2018-03-05 |
| 1538471099 | Jacob Royle Hopping | Surgery | 1001 Main St Ste 300, Peoria, IL 61606 | 2010-07-12 |
| 1881906410 | Heather Jefford | Clinical Nurse Specialist | 1001 Main St, 3rd Floor, Peoria, IL 61606 | 2010-07-12 |
| 1306874128 | David L Crawford | Surgery | 1001 Main Street, Suite 300, Peoria, IL 61606 | 2006-06-29 |
| Find all providers in zip 61606 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386258689 | Joshua Dutton | Dentist | 8325 W Happy Valley Rd Unit 100, Peoria, AZ 85383-4361 | 2020-09-03 |
| 1750908992 | Asfia Kauser | Dentist | 4325 W Castleton Rd, Peoria, IL 61615-2821 | 2020-07-04 |
| 1528694247 | Lake Pleasant Kids Dentists and Orthodontics, LLP | Dentist | 24775 North Lake Pleasant Parkway Suite 104, Peoria, AZ 85383 | 2020-03-13 |
| 1114588217 | Kong Xing Wang | Dentist | 320 East Armstrong Ave, Peoria, IL 61603 | 2019-06-28 |
| 1669958781 | Plaza Family Dental Inc | Dentist | 9145 W Thunderbird Rd Ste H105, Peoria, AZ 85381-4820 | 2018-07-11 |
| 1578058293 | Bhumikaben Patel | Dentist | 5400 W Sienna Ln Apt 2202, Peoria, IL 61615-7857 | 2018-06-25 |
| 1265926729 | Vogue Dental Peoria LLC | Dentist | 3510 N University St Ste A, Peoria, IL 61604-1346 | 2018-06-19 |
| 1841784493 | Jeffrey Jay Chen | Dentist | 9016 N Allen Rd Ste B, Peoria, IL 61615-1560 | 2018-06-18 |
| 1013422138 | Joseph Nicholas Taylor | Dentist | 7310 N Villa Lake Dr Ste B, Peoria, IL 61614-8268 | 2017-12-12 |
| 1457881351 | Jaclyn Macdonald | Dentist | 2214 N University St, Peoria, IL 61604-3221 | 2017-06-14 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.