David Ralph Trost, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-016607 Issued in IL

Practice address

134 McKinley St
East Peoria, IL 61611-2550

Phone

(309) 699-6770

Fax

(309) 699-6771

NPI assigned

Jan 23, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1033263173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 MCKINLEY ST",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616112550",
            "telephone_number": "309-699-6770",
            "fax_number": "309-699-6771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 MCKINLEY ST",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616112550",
            "telephone_number": "309-699-6770",
            "fax_number": "309-699-6771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TROST",
        "first_name": "DAVID",
        "middle_name": "RALPH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-016607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019-016607",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rosalyn T Toombs, COTA/L
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• Melissa Vanderheiden

• General Practice Dentistry in East Peoria, IL
• Providers in East Peoria, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.