OPTIM DENTAL PEORIA-1 LLC (NPI# 1962943290) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962943290 |
| Entity Type | Organization |
| Organization Name | OPTIM DENTAL PEORIA-1 LLC |
| Practice Address |
1200 W Main St Ste 9 Peoria IL 61606-1218 |
| Practice Telephone | 3097779777 |
| Mailing Telephone | 3097779777 |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2017-03-20 |
| Authorized Official Name | SRINIVAS DURSHANAPALLI (PRESIDENT) |
| Authorized Official Telephone | 2173035955 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Street Address |
1200 W MAIN ST STE 9 |
| City | PEORIA |
| State | IL |
| Zip Code | 61606-1218 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194379271 | Jai Krishna Srikanth Kolliboyana | Dentist | 1200 W Main St Ste 9, Peoria, IL 61606-1218 | 2019-07-28 |
| 1417475146 | Allen Jaywan Bai | Dentist | 1200 W Main St Ste 9, Peoria, IL 61606-1218 | 2017-09-01 |
| 1740704832 | Venkat Yashaswi Kondapalli | Dentist | 1200 W Main St Ste 9, Peoria, IL 61606-1218 | 2017-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194292334 | Kelley Stork | Speech-Language Pathologist | 807 W Columbia Terrace, Peoria, IL 61606 | 2018-10-25 |
| 1689140519 | Emma Cristine Tully | Speech-Language Pathologist | 1619 W. Fredonia Ave, Peoria, IL 61606 | 2018-10-18 |
| 1316492432 | Jennifer Greenwood | Nurse Practitioner | 1001 Main St Ste 500a, Peoria, IL 61606 | 2016-08-18 |
| 1104944974 | Robert I Martin | Preventive Medicine | 1127 N North Street, Peoria, IL 61606 | 2007-03-27 |
| 1023062312 | Saint Francis Medical Center | Physical Medicine & Rehabilitation | 100 Ne Randoph Street, Peoria, IL 61606 | 2006-05-20 |
| 1174573307 | Cpo Services, Inc | Prosthetic/Orthotic Supplier | 741 West Main Street, Peoria, IL 61606 | 2006-05-10 |
| 1174025357 | Amy M Durst | Nurse Practitioner | 1001 Main St Ste 500a, Peoria, IL 61606 | 2018-03-05 |
| 1538471099 | Jacob Royle Hopping | Surgery | 1001 Main St Ste 300, Peoria, IL 61606 | 2010-07-12 |
| 1881906410 | Heather Jefford | Clinical Nurse Specialist | 1001 Main St, 3rd Floor, Peoria, IL 61606 | 2010-07-12 |
| 1306874128 | David L Crawford | Surgery | 1001 Main Street, Suite 300, Peoria, IL 61606 | 2006-06-29 |
| Find all providers in zip 61606 | ||||
| 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 |
|---|---|---|---|---|
| 1013530187 | Core Family Dental, LLC | Dentist | 13460 N 94th Dr Ste K4, Peoria, AZ 85381-4249 | 2020-05-24 |
| 1982248084 | Westbrook Dental Center, P.a. | Dentist | 9276 W Union Hills Dr Ste A, Peoria, AZ 85382-8206 | 2019-10-31 |
| 1699318725 | Mint Dental Care LLC | Dentist | 8258 W Thunderbird Rd Ste 201, Peoria, AZ 85381-4777 | 2019-10-21 |
| 1548822497 | Katherine M Unes | Dentist | 11323 N Pawnee Rd, Peoria, IL 61615-9796 | 2019-07-01 |
| 1992296073 | George S Hariri | Dentist | 7777 W Deer Valley Rd Ste 160, Peoria, AZ 85382-2104 | 2018-05-23 |
| 1619485869 | Thunderbird Dental Studio | Dentist | 9179 W Thunderbird Rd Ste 107, Peoria, AZ 85381-4875 | 2018-01-22 |
| 1588179311 | Dr. Marc C Thevenin Jr. PC | Dentist | 5116 N Big Hollow Rd Ste 101, Peoria, IL 61615-3514 | 2017-12-01 |
| 1629592423 | Jessica Leigh Howard | Dentist | 7966 W Thunderbird Rd Ste 101, Peoria, AZ 85381-4902 | 2017-08-02 |
| 1588193718 | Darren Anderson | Dentist | 28451 N Vistancia Blvd Ste 101, Peoria, AZ 85383-2090 | 2017-06-10 |
| 1154772879 | Kristina Wilson | Dentist | 10184 W Happy Valley Rd Ste 195, Peoria, AZ 85383-1254 | 2016-06-23 |
| 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.