Pine Glen Dental Group, LTD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

060010781 Issued in IL

Legal business name

PINE GLEN DENTAL GROUP, LTD

Practice address

838 W Glen Ave
Peoria, IL 61614-4835

Phone

(309) 691-1990

Fax

(309) 691-9112

NPI assigned

Apr 6, 2012

Last updated

Apr 6, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Lori A Rice, DDSNPI 1063620771

Title

President

Phone

(309) 691-1990

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lori Anne Pollard Rice, DDS

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1063620771
  NPD (past) Authorized official
• Robert Michael Pollard, DDS

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1801004502
  NPD (past)
• Eric Thomas Sudholt, D.M.D.

  • Dentist
  • Peoria, IL
  • NPI 1467759944
  NPD (past)

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

{
    "created_epoch": "1333670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333670400000",
    "number": "1053677765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "838 W GLEN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144835",
            "telephone_number": "309-691-1990",
            "fax_number": "309-691-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "838 W GLEN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144835",
            "telephone_number": "309-691-1990",
            "fax_number": "309-691-9112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE GLEN DENTAL GROUP, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-06",
        "last_updated": "2012-04-06",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-691-1990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "060010781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather R Pierce
• Lisa M Pierce, CPNP-AC
• Alexa Pieri, PA
• Evan C Pike, M.D.
• Joseph Daniel Pilon, APRN, FNP-BC
• Pine Glen Dental Group, LTD
• Pinnacle Anesthesia Consultants LLC
• Arun C Pinto, MD
• Rosemarie L. Piper, P.T.
• Stephanie M Piquard-Capranica

• General Practice Dentistry in Peoria, IL
• Providers in 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 Apr 6, 2012; 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.