DENTAL SEALANTS & MORE (NPI# 1770755852) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770755852 |
| Entity Type | Organization |
| Organization Name | DENTAL SEALANTS & MORE |
| Practice Address |
2126 N. University St. Peoria IL 61604 |
| Practice Telephone | 3093394433 |
| Practice Fax Number | 3094061326 |
| Mailing Telephone | 3093394433 |
| Mailing Fax Number | 3094061326 |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2017-02-08 |
| Authorized Official Name | RENEE KATHERINE DIETZ (PRESIDENT) |
| Authorized Official Telephone | 3093394433 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | Y |
| Parent Organization Name | DENTAL SEALANTS & MORE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 019-010639 | IL | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | DORAL DENTAL OF ILLINOIS | 1001319 | 01 |
| Street Address |
2126 N. UNIVERSITY ST. |
| City | PEORIA |
| State | IL |
| Zip Code | 61604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205357928 | Nydia I Rodriguez | Nurse's Aide | 3305 N Finnell Ave, Peoria, IL 61604 | 2017-07-03 |
| 1720327976 | Brin Diagnostics Inc. | Clinical Medical Laboratory | 3216 W Kenwood, West Peoria, IL 61604 | 2013-02-07 |
| 1225373715 | Ngocyen Thi Ngo | Pharmacist | 2515 N Knoxville Avenue, Peoria, IL 61604 | 2012-12-10 |
| 1194027003 | Schelly Chiropractic, Inc | Chiropractor | 1208 W Loucks, Peoria, IL 61604 | 2010-11-29 |
| 1821266123 | David L Krick | Dentist | 2022 N University, Peoria, IL 61604 | 2008-02-20 |
| 1568658409 | Advanced Physicians Health Care, S.c. | Chiropractor | 1200 West Loucks Ave, Peoria, IL 61604 | 2007-09-24 |
| 1902006000 | Noel Liu | Dentist | 3127 N. University St., Unit C, Peoria, IL 61604 | 2007-07-18 |
| 1568586386 | Susan B Bordenave-bishop | Dentist | 2116 N. Sheridan, Peoria, IL 61604 | 2007-03-19 |
| 1174689897 | Paul Anthony Amodeo | Dentist | 3100 N Dries Lane, Suite 301, Peoria, IL 61604 | 2006-12-28 |
| 1407948607 | Andrew Jon Heritch | Psychiatry & Neurology | 3116 N Dries Ln, #201, Peoria, IL 61604 | 2006-09-28 |
| Find all providers in zip 61604 | ||||
| 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.