ILLINOIS VALLEY ENDODONTICS LLC (NPI# 1407031305) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407031305 |
| Entity Type | Organization |
| Organization Name | ILLINOIS VALLEY ENDODONTICS LLC |
| Other Organization Name | LEE M. CERESA DDS |
| Practice Address |
1601 4th St Peru IL 61354-3507 |
| Practice Telephone | 8152243636 |
| Practice Fax Number | 8152201479 |
| Mailing Telephone | 8152243636 |
| Mailing Fax Number | 8152201479 |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2008-01-09 |
| Authorized Official Name | DR. LEE MICHAEL CERESA (OWNER/DENTIST) |
| Authorized Official Telephone | 8152243636 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
IL | Dental Providers |
| Other Name | Type Code |
|---|---|
| Lee M. Ceresa DDS | Doing Business As Name - Organization |
| Street Address |
1601 4TH ST |
| City | PERU |
| State | IL |
| Zip Code | 61354-3507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063513117 | Lee Michael Ceresa | Dentist | 1601 4th St, Peru, IL 61354-3507 | 2006-09-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750247 | Saida Samedova | Optometrist | 5255 Il-251, Peru, IL 61354 | 2020-11-06 |
| 1205469483 | Illinois Valley Community Hospital | Registered Nurse | 1403 Sixth Street, Peru, IL 61354 | 2020-02-17 |
| 1689228322 | Zhong Xue | Dentist | 5301 Il-251, Ste A, Peru, IL 61354 | 2019-07-31 |
| 1003281668 | Christopher Shane Smith | Physical Therapist | 1400 Midtown Road, Peru, IL 61354 | 2015-12-08 |
| 1770823197 | Muscle Pain Clinic Inc | Chiropractor | 4231 Progress Blvd Ste 4, Peru, IL 61354 | 2013-02-21 |
| 1306194451 | Vijaya Lakshmi Bathina | Dentist | 5301 Route 251, Peru, IL 61354 | 2012-08-21 |
| 1225305634 | Walgreens | Point of Service | 1033 Shooting Park Road, Peru, IL 61354 | 2011-11-30 |
| 1811293574 | Charles Riva | Physical Therapist | 4461 N. Progress Blvd., Peru, IL 61354 | 2011-01-28 |
| 1932403896 | Emerging Vision, Inc | Eyewear Supplier (Equipment, not the service) | 3940 Route 251, Peru Mall Suite F-1, Peru, IL 61354 | 2011-01-06 |
| 1457668170 | Illinois Valley Community Hospital | Nurse Practitioner | 5307 Route 251, Peru, IL 61354 | 2010-09-01 |
| Find all providers in zip 61354 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235348657 | Susan Lynn Zerrahn | Dentist | 2993 Main St, Suite 2, Peru, NY 12972-0343 | 2007-05-22 |
| 1063513117 | Lee Michael Ceresa | Dentist | 1601 4th St, Peru, IL 61354-3507 | 2006-09-25 |
| 1184889644 | Mark Alan Henry | Dentist | 2050 Marquette Rd, Suite 300, Peru, IL 61354 | 2008-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669089777 | Sebastian Przybylo, Dmd, Pllc | Dentist | 350 S Northwest Hwy Ste 116, Park Ridge, IL 60068-4262 | 2020-09-24 |
| 1770126740 | Old Orchard Endodontics | Dentist | 4905 Old Orchard Ctr Ste 216, Skokie, IL 60077-4741 | 2019-10-23 |
| 1194380741 | Vasiliki Kytridou | Dentist | 2800 College Avenue Southern Il University School of De, Building 285, Alton, IL 62002 | 2019-05-08 |
| 1134782592 | Endodontics of Springfield | Dentist | 997 Clock Tower Dr Ste C, Springfield, IL 62704-1399 | 2019-04-20 |
| 1942793815 | Millennium Dental Specialist | Dentist | 1624 W Division St Ste B, Chicago, IL 60622-3908 | 2018-06-14 |
| 1588163364 | Advanced Endodontics, PC | Dentist | 103 S. Greenleaf Street, Suite K, Gurnee, IL 60031 | 2018-02-07 |
| 1518488055 | Seth Thomas Barnett | Dentist | 3601 General Electric Rd Ste 6, Bloomington, IL 61704-8566 | 2017-07-06 |
| 1023562857 | Jwwdental LLC | Dentist | 808 E Woodfield Rd, Suite 300, Schaumburg, IL 60173-4816 | 2016-08-10 |
| 1629453378 | Charles Richard Neach | Dentist | 801 S Paulina St Rm 302a, Chicago, IL 60612-7210 | 2015-07-23 |
| 1619360096 | Rajan Sharma | Dentist | 6319 Fairview Ave Ste 103, Westmont, IL 60559-2889 | 2015-03-10 |
| Find all providers with the same taxonomy | ||||
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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.