Katherine Mae Shadid, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019.035294 Issued in IL

Practice address

843 W Glen Ave
Peoria, IL 61614-4834

Phone

(309) 691-9421

NPI assigned

Jul 2, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Donlan Dental Group

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1306902499
  NPD (past)
• Kids First Dental Group

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1609141464
  NPD (past)
• Laura J Donlan DDS PC

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1083767396
  NPD (past)

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

{
    "created_epoch": "1719878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1144066747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11120 N BROOKHAVEN CT",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "843 W GLEN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144834",
            "telephone_number": "309-691-9421"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7314 N Willow Lake Ct Ste D",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616148289",
            "country_code": "US",
            "telephone_number": "309-692-0175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHADID",
        "first_name": "KATHERINE",
        "middle_name": "MAE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-02",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.035294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aruna Krishnaiah Setty, DPT
• Richard McKinley Setzer, MSW, LSW
• Sheraden K Seward, D.O.
• Linda Marie Sewell Wilson, RPH, PHARMD
• Hady Sfeir
• Andrew John Shadrach, MD
• Mildred Elaine Shafer, APN
• Terri Fran Shafer, LCPC
• Mary Shah-Cox, D.D.S.
• Anushi Shah, M.D.

• Dentist in Peoria, IL
• Providers in Peoria, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; 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.