DENTAL PROFESSIONALS OF ILLINOIS, P.C. (NPI# 1386985380) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386985380 |
| Entity Type | Organization |
| Organization Name | DENTAL PROFESSIONALS OF ILLINOIS, P.C. |
| Other Organization Name | FAMILY DENTAL CARE OF EAST PEORIA |
| Practice Address |
368 W. Washington St. East Peoria IL 61611 |
| Practice Telephone | 3096944444 |
| Practice Fax Number | 3096943361 |
| Mailing Telephone | 3096944444 |
| Mailing Fax Number | 3096943361 |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2014-01-09 |
| Authorized Official Name | LINDSAY BEARDEN (INSURANCE/CREDENTIALING) |
| Authorized Official Telephone | 2175405100 |
| Is Organization Subpart | Y |
| Parent Organization Name | DENTAL PROFESSIONALS OF ILLINOIS, P.C. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Family Dental Care of East Peoria | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669092177 | Dental Professionals of Illinois, P.C. | Dentist | 3419 Orchard Rd, Oswego, IL 60543-5005 | 2020-04-24 |
| 1790262434 | Dental Professionals of Illinois, P.C. | Dentist | 1402 S Us Highway 12, Fox Lake, IL 60020-1252 | 2018-07-25 |
| 1255884623 | Dental Professionals of Illinois, P.C. | Dentist | 2740 Prairie Crossing Drive, Springfield, IL 62711 | 2016-08-02 |
| 1043609167 | Dental Professionals of Illinois, P.C. | Dentist | 9990 W 190th St, Suite D, Mokena, IL 60448-8188 | 2015-01-13 |
| 1144623273 | Dental Professionals of Illinois, P.C. | Dentist | 540 W Walnut St, Oglesby, IL 61348-1400 | 2014-10-03 |
| 1053713966 | Dental Professionals of Illinois, P.C. | Dentist | 1411 W Lane Rd Ste B, Machesney Park, IL 61115 | 2014-09-23 |
| 1346651577 | Dental Professionals of Illinois, P.C. | Dentist | 1490 Douglas Rd, Oswego, IL 60543-5106 | 2014-05-09 |
| 1972925584 | Dental Professionals of Illinois, P.C. | Dentist | 6631 Grand Ave Ste 1, Gurnee, IL 60031-5284 | 2014-01-16 |
| 1871842112 | Dental Professionals of Illinois, P.C. | Dentist | 12605 Troxler Ave, Highland, IL 62249 | 2012-08-31 |
| 1821242603 | Dental Professionals of Illinois, P.C. | Dentist | 1840 Dekalb Ave, Suite B, Sycamore, IL 60178 | 2008-11-06 |
| Street Address |
368 W. WASHINGTON ST. |
| City | EAST PEORIA |
| State | IL |
| Zip Code | 61611 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548736390 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 133 Spinder Drive Ste 4015, East Peoria, IL 61611 | 2018-10-19 |
| 1083128474 | Abc Counseling & Family Services | Clinic/Center | 111 W. Washington St., Suite 410b, East Peoria, IL 61611 | 2017-11-22 |
| 1386162253 | Cheryl Denise Hagedorn | Speech-Language Pathologist | 306 Eckley Avenue, East Peoria, IL 61611 | 2017-08-31 |
| 1710342076 | Rebecca Uthe | Physical Therapist | 901 Illini Drive, East Peoria, IL 61611 | 2015-12-30 |
| 1669812103 | Christopher Webb | Dentist | 360 West Washington Street, East Peoria, IL 61611 | 2013-06-28 |
| 1730432675 | Synergy Healthcare Physical Medicine Sc | Chiropractor | 350 Cimmeron Drive, East Peoria, IL 61611 | 2012-10-16 |
| 1508122029 | Daniel Benjamin Gans | Radiology | 111 Oakwood Rd, East Peoria, IL 61611 | 2012-04-10 |
| 1326288390 | Sara Sabry Fouad Rizk | Pharmacist | 2540 East Washington Street, East Peoria, IL 61611 | 2009-03-03 |
| 1356466007 | Tazwood Mental Health Center, Inc. | Counselor | 111 W. Washington Street, Suite 230, East Peoria, IL 61611 | 2007-03-20 |
| 1548315575 | Thomas R. Nalepka D.d.s | Dentist | 809 W Camp St, East Peoria, IL 61611 | 2007-01-23 |
| Find all providers in zip 61611 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548315575 | Thomas R. Nalepka D.d.s | Dentist | 809 W Camp St, East Peoria, IL 61611 | 2007-01-23 |
| 1033263173 | David Ralph Trost | Dentist | 134 Mckinley St, East Peoria, IL 61611-2550 | 2007-01-23 |
| 1720154149 | Viktor Maister | Dentist | 2404 E Washington St, East Peoria, IL 61611-1859 | 2006-11-28 |
| 1740842129 | Sung Kyung Kim | Dentist | 502 Riverside Dr, East Peoria, IL 61611-2068 | 2019-07-05 |
| 1407415250 | Ricardo Ulises Melchor-palma | Dentist | 1001 Illini Dr, East Peoria, IL 61611-1883 | 2019-06-06 |
| 1649764176 | Jiaying Ren | Dentist | 1001 Illini Dr, East Peoria, IL 61611-1883 | 2018-06-18 |
| 1962765875 | Joshua A Hudson | Dentist | 2404 E Washington St, East Peoria, IL 61611-1859 | 2012-06-18 |
| 1164659918 | James T Gray | Dentist | 2404 E Washington St, East Peoria, IL 61611-1859 | 2009-06-19 |
| 1376730200 | Michael Robert Cusack | Dentist | 2404 E Washington St, East Peoria, IL 61611-1859 | 2007-09-25 |
| 1841344173 | Robert Edward Cross | Dentist | 134 Mckinley St, East Peoria, IL 61611-2550 | 2007-01-23 |
| Find all providers in EAST PEORIA | ||||
| City | EAST PEORIA |
| Zip Code | 61611 |
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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.