Kenneth Delaine Meiss, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-024524 Issued in IL

Practice address

910 W Glen Ave
Peoria, IL 61614-4879

Phone

(309) 682-9802

Fax

(309) 682-9809

NPI assigned

Jan 25, 2007

Sex

Male

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

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Kenneth D. Meiss D.M.D. LTD.

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1790906139
  NPD (past) Authorized official

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424390400000",
    "number": "1336294537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 W GLEN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144879",
            "telephone_number": "309-682-9802",
            "fax_number": "309-682-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 W GLEN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144879",
            "telephone_number": "309-682-9802",
            "fax_number": "309-682-9809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEISS",
        "first_name": "KENNETH",
        "middle_name": "DELAINE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2015-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-024524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shirley Mei
• Lestari Wisnu Meier, MA NCC LPC
• Megan Elizabeth Meinke, MD
• Curt Meiss, L.C.P.C.
• Jordan Michael Meiss, M.D.
• Mary Jennifer Sue Meister, LCSW
• Robert A Meister, M.D.
• Melissa Millinger Counseling
• Melissa Shane Counseling Services LLC
• Natalie Mencis

• 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 Feb 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.