NPIMap

Organization Active NPI

John B. Dale, DMD, Ms, P.C.

  • Endodontics
  • Peoria, IL
National Provider Identifier
1275606592
Registry record updated Jan 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
021.002048 Issued in IL
Legal business name
JOHN B. DALE, DMD, MS, P.C.
Practice address
7314 N Willow Lake CT
Suite a
Peoria, IL 61614-8277
Phone
(309) 691-9100
Fax
(309) 691-6755
NPI assigned
Nov 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2012

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

Authorized official

Name
Dr. John Bruce Dale, D.M.D., M.S.
Title
Doctor
Phone
(309) 691-9100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X 021.002048 IL Primary

Addresses

Primary practice location

7314 N Willow Lake CT
Suite a
Peoria, IL 61614-8277

Mailing address

7314 N Willow Lake CT
Suite a
Peoria, IL 61614-8277
Phone (309) 691-9100

National Provider Directory

National Provider Directory

Locations

7314 N Willow Lake Ct
Ste A
Peoria, IL 61614
Phone (309) 691-9100

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327881600000",
    "number": "1275606592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7314 N WILLOW LAKE CT",
            "address_2": "SUITE A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148277",
            "telephone_number": "309-691-9100",
            "fax_number": "309-691-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7314 N WILLOW LAKE CT",
            "address_2": "SUITE A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148277",
            "telephone_number": "309-691-9100",
            "fax_number": "309-691-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN B. DALE, DMD, MS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2012-01-30",
        "status": "A",
        "authorized_official_last_name": "DALE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "309-691-9100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D., M.S."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "IL",
            "license": "021.002048",
            "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 30, 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.