PEORIA DENTAL CARE (NPI# 1851909345) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851909345 |
| Entity Type | Organization |
| Organization Name | PEORIA DENTAL CARE |
| Practice Address |
4517 N Rockwood Dr Peoria IL 61615-3841 |
| Practice Telephone | 3096880121 |
| Mailing Telephone | 3096880121 |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2020-07-21 |
| Authorized Official Name | ROBERT WYNN (DENTIST) |
| Authorized Official Telephone | 3096880121 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Street Address |
4517 N ROCKWOOD DR |
| City | PEORIA |
| State | IL |
| Zip Code | 61615-3841 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144352170 | Robert M. Wynn | Dentist | 4517 N Rockwood Dr, Peoria, IL 61615-3841 | 2007-03-13 |
| 1619350725 | Matthew Liesen | Dentist | 4517 N Rockwood Dr, Peoria, IL 61615-3841 | 2015-07-07 |
| 1760746747 | Micah A Roberts | Dentist | 4517 N Rockwood Dr, Peoria, IL 61615-3841 | 2012-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124627906 | Lance Jay Bucher | Occupational Therapist | 8600 Il-91, Peoria, IL 61615 | 2020-10-22 |
| 1093327496 | Angela Mitchell | Speech-Language Pathologist | 3903 W Ridgeview Dr, Peoria, IL 61615 | 2020-08-18 |
| 1578110680 | Emily E Buenting | Audiologist | 8600 Il Route 91, Suite 300, Peoria, IL 61615 | 2019-08-22 |
| 1730655572 | Sylwia M. Budzik | Physician Assistant | 8600 Illinois Rt. 91, Suite 300, Peoria, IL 61615 | 2018-10-19 |
| 1487169207 | Heather Hart | Registered Nurse | 9016 N. Scrimshaw Dr. Apt 104, Peoria, IL 61615 | 2017-12-04 |
| 1528586849 | Leanne Runyon | Speech-Language Pathologist | 10723 Collett Dr., Peoria, IL 61615 | 2017-09-07 |
| 1467974196 | Elizabeth A Mcleod | Nurse Practitioner | 8600 Illinois Route 91, Suite 130, Peoria, IL 61615 | 2017-07-14 |
| 1790223022 | Janet Warner | Counselor | 8914 North Prarie Court, Peoria, IL 61615 | 2017-02-07 |
| 1437524022 | Brooke Bisping | Dietitian, Registered | 7610 North Orange Prairie Road, Peoria, IL 61615 | 2015-12-08 |
| 1003292111 | Crystal Ann Casper | Dietitian, Registered | 7610 N Orange Prarie Road, Peoria, IL 61615 | 2015-07-31 |
| Find all providers in zip 61615 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912520347 | Dr. Reese Turner, Dds, PC | Clinic/Center | 9059 W Lake Pleasant Pkwy Ste A100, Peoria, AZ 85382-8393 | 2020-05-20 |
| 1386280840 | Tru Dental LLC | Clinic/Center | 8325 W. Happy Valley Rd, Building 1 Suite 100, Peoria, AZ 85383-8538 | 2019-11-20 |
| 1609343987 | Dental Excellence Pllc | Clinic/Center | 20403 N Lake Pleasant Rd Ste 121, Peoria, AZ 85382-9707 | 2018-10-25 |
| 1417445099 | Cooperman Family Dentistry Pllc | Clinic/Center | 25101 N Lake Pleasant Pkwy # B-1335, Peoria, AZ 85383-1386 | 2018-04-29 |
| 1992202139 | Peoria Dental LLC | Clinic/Center | 7417 N Knoxville Ave, Peoria, IL 61614-2019 | 2018-04-12 |
| 1598262917 | A Tender Dental Care V LLC | Clinic/Center | 25355 N Lake Pleasant Pkwy Unit 103, Peoria, AZ 85383-1504 | 2018-04-11 |
| 1578987699 | Cactus Dental Care LLC | Clinic/Center | 7440 W Cactus Rd Ste A18, Peoria, AZ 85381-9534 | 2014-02-10 |
| 1588897789 | Rio Vista Dental Arts Pllc | Clinic/Center | 9145 W Thunderbird Rd, H-105, Peoria, AZ 85381-4820 | 2009-09-03 |
| 1700490992 | Tooth Corps Pllc | Clinic/Center | 13660 N 94th Dr Ste B1, Peoria, AZ 85381-4848 | 2020-09-03 |
| 1689283814 | Core Family Dental | Clinic/Center | 13460 N 94th Dr Ste K4, Peoria, AZ 85381-4249 | 2020-07-23 |
| 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.