Associated Oral and Maxillofacial Surgeons of Peoria, LTD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

019024407 Issued in IL

Legal business name

ASSOCIATED ORAL AND MAXILLOFACIAL SURGEONS OF PEORIA, LTD

Practice address

5720 N Knoxville Ave
Peoria, IL 61614-4331

Phone

(309) 682-1213

Fax

(309) 682-5386

NPI assigned

Jun 23, 2006

Organization subpart

No

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

Authorized official

Name

Robyn Wolfe

Title

Practice Leader

Phone

(309) 682-1249

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Associated Oral Surgeons Other name

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nathan D Schroeder, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Peoria, IL
  • NPI 1356558282
  NPD
• Jill Emily Gibson, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Greenville, SC
  • NPI 1437648045
  NPD (past)
• John J Otten, M.D., D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Omaha, NE
  • NPI 1902930159
  NPD (past)

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1154357291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5720 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144331",
            "telephone_number": "309-682-1213",
            "fax_number": "309-682-5386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5720 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144331",
            "telephone_number": "309-682-1213",
            "fax_number": "309-682-5386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED ORAL AND MAXILLOFACIAL SURGEONS OF PEORIA, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-23",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A",
        "authorized_official_last_name": "WOLFE",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_title_or_position": "PRACTICE LEADER",
        "authorized_official_telephone_number": "309-682-1249"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019023700",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019024407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LARRY D. OTTE LICENSE NUM",
            "identifier": "019024407",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN J. OTTEN LICENSE NUM",
            "identifier": "019023700",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Associated Oral Surgeons",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Fizzah Asif
• Sohiub Nizar Assaf, MD
• Mahilet Fekadu Assefa, MD
• Associated Anesthesiologists, S.C.
• Associated Anesthesiologists, SC
• Associated Orthopedics SC
• Associated Surgical Group, SC
• Associated University Neurosurgeons SC
• Associates in Dentistry
• Associates in Mental Health, SC

• Oral and Maxillofacial Surgery (Dentist) in Peoria, IL
• Providers in Peoria, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.