NPIMap

Organization Active NPI

Secure Dental LLC

  • Dentist
  • Peoria, IL
National Provider Identifier
1154607422
Registry record updated Jan 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019027468 Issued in IL
Legal business name
SECURE DENTAL LLC
Practice address
3127 N. University St.
Peoria, IL 61604
Phone
(309) 681-8888
NPI assigned
Oct 31, 2011
Last updated
Jan 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2012

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

Authorized official

Name
Dr. Noel Liu, D.D.S
Title
Member
Phone
(815) 670-2923

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019027468 IL Primary

Addresses

Primary practice location

3127 N. University St.
Peoria, IL 61604

Mailing address

1695 Divine Dr
Rockford, IL 61107-5417
Phone (815) 670-2923

National Provider Directory

National Provider Directory
Tax ID family
Secure Dental LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3127 N University St
Peoria, IL 61604
Phone (309) 681-8888

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327622400000",
    "number": "1154607422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1695 DIVINE DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075417",
            "telephone_number": "815-670-2923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3127 N. UNIVERSITY ST.",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61604",
            "telephone_number": "309-681-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECURE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-31",
        "last_updated": "2012-01-27",
        "status": "A",
        "authorized_official_last_name": "LIU",
        "authorized_official_first_name": "NOEL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "815-670-2923",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019027468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.