Julia Kishanie Persaud, DDS
Individual provider Active NPI General Practice Dentistry · Chillicothe, IL
NPI 1043050735 · NPPES record last updated May 29, 2024
Key facts
- NPI
- 1043050735
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019.035015 (IL)
- Practice address
- 607 S 4TH St Ste B
Chillicothe, IL 61523-2277 - Phone
- (309) 274-6237
- NPI assigned
- May 29, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240923000325 | IL | Practitioner - Dentist | 1153862867 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.035015 | IL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.035015 | IL | Yes |
Addresses
Primary practice location
607 S 4TH St Ste B
Chillicothe, IL 61523-2277
Mailing address
31 Kingsley Rd
Huntington, NY 11743-6428
Phone (516) 413-8873
Other practice location 1
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (309) 655-2000
Other providers in Chillicothe, IL
- Kristie L. Mueller
- Joshua Travis Murphy
- Naperville Health Clinic, S.C.
- Christopher William Nau
- Sean Lawrence Nolph
- Proctor Health Systems
- Proctor Health Systems
- Professional Therapy Services, Inc.
- Azizur Rehman
- Restoring Hope Counseling, LLC
All providers in Chillicothe, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.