Dr. Paul & Dr. Anderson, Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1916423 Issued in IL

Legal business name

DR. PAUL & DR. ANDERSON, DENTAL PC

Practice address

521 W Lake Ave
Peoria, IL 61614-6020

Phone

(309) 682-0770

NPI assigned

Dec 4, 2014

Organization subpart

No

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

Authorized official

Name

Roger Paul, DMD

Title

Dentist

Phone

(309) 682-0770

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1417651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1154728228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 W. LAKE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-682-0770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 W LAKE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616146020",
            "telephone_number": "309-682-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. PAUL & DR. ANDERSON, DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-04",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "PAUL",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "309-682-0770",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "1916423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Dec 4, 2014; 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.