PETERSON DENTAL CARE LLC (NPI# 1316430952) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1316430952 |
Entity Type | Organization |
Organization Name | PETERSON DENTAL CARE LLC |
Practice Address |
2501 W Iles Ave Ste A Springfield IL 62704-6482 |
Mailing Address |
1700 Mound Rd Jacksonville IL 62650-2260 |
Practice Telephone | 2177874015 |
Mailing Telephone | 6307809964 |
Enumeration Date | 2018-06-08 |
Last Update Date | 2018-06-08 |
Authorized Official Name | JAMES PETERSON (OWNER) |
Authorized Official Telephone | 6307809964 |
Authorized Official Credential | DDS |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QD0000X |
Clinic/Center Specialization: Dental |
019029045 | IL | Ambulatory Health Care Facilities |
Street Address |
2501 W ILES AVE STE A |
City | SPRINGFIELD |
State | IL |
Zip Code | 62704-6482 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902394901 | Hillary Haaker | Occupational Therapist | 2035 W Iles, Suite C, Springfield, ID 62704 | 2018-04-25 |
1871095364 | Edward Doyle Slifer Sr. | Pathology | 2117 Greenside Drive, Spring Field, IL 62704 | 2018-03-01 |
1598263345 | Santarelli & Feller Dental Group | Dentist | 1140 Rickard Road, Suite B, Springfield, IL 62704 | 2018-01-26 |
1447774757 | Lisa Ann Rogers | Developmental Therapist | 2101 Lexington Dr, Apt 3, Springfield, IL 62704 | 2017-07-28 |
1730611286 | Mindi Rowe | Occupational Therapist | 2508 County Rd 4 1/2 E, Springfield, IL 62704 | 2017-04-03 |
1366992208 | Jayme Jordan | Contractor | 2409 Westchester Blvd, Springfield, IL 62704 | 2016-10-04 |
1154793974 | Dina Payne | Social Worker | 917 Clocktower Drive, Suite 600, Springfield, IL 62704 | 2015-10-21 |
1770959819 | James R Reynolds | Hearing Instrument Specialist | 2347 W Monroe St, Springfield, IL 62704 | 2015-08-12 |
1336576495 | Emily Jane Dungey | Counselor | 920 S Spring St Ste 1300, Springfield, IL 62704 | 2013-10-03 |
1942552161 | Jeannie Marie Hundley | Specialist/Technologist, Other | 2921 Monvale Drive, Springfield, IL 62704 | 2012-10-11 |
Find all providers in zip 62704 |
Taxonomy Code | 261QD0000X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Dental |
Definition to come... |
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1689228140 | Dr Dental of Massachusetts PC | Clinic/Center | 1101 Boston Road, Springfield, MA 01119 | 2019-08-01 |
1275094864 | Itooth Family Dentistry, LLC | Clinic/Center | 3211 E Battlefield St Ste 100, Springfield, MO 65804-4071 | 2019-03-27 |
1164918868 | Noble Family Dental PC | Clinic/Center | 665 Boston Rd, Springfield, MA 01119-1303 | 2018-07-05 |
1447765029 | Dental 32, L.L.C. | Clinic/Center | 2142 S Brentwood Blvd, Springfield, MO 65804-2539 | 2017-12-05 |
1922435148 | Kelly Dental LLC | Clinic/Center | 1655 S. Enterprise Ave Ste. A-3, Springfield, MO 65804 | 2013-10-02 |
1184986077 | All About Smiles Lc | Clinic/Center | 1717 E Cherokee St, Suite 104, Springfield, MO 65804-2335 | 2012-06-15 |
1285939157 | Derek R. Kaelin D.d.s, LLC | Clinic/Center | 4205 S Nature Center Way, Springfield, MO 65804-4921 | 2011-01-24 |
1295030203 | Derek R. Kaelin, D.d.s, LLC | Clinic/Center | 2105 W Kearney St Ste A, Springfield, MO 65803-1666 | 2011-01-21 |
1477867612 | Springfield Community Dental Clinic | Clinic/Center | 1 Armory Sq, Springfield, MA 01105-1700 | 2010-07-29 |
Find all providers in SPRINGFIELD |
City | SPRINGFIELD |
Zip Code | 62704 |
Please comment or provide details below to improve the information on PETERSON DENTAL CARE LLC.
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.