William E. Cusack, D.D.S., LTD.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

WILLIAM E. CUSACK, D.D.S., LTD.

Practice address

5013 N University St Ste 2
Peoria, IL 61614-4796

Phone

(309) 693-2220

Fax

(309) 693-2272

NPI assigned

Oct 15, 2024

Organization subpart

No

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

Authorized official

Name

Kimberly Sue Cusack

Title

President

Phone

(309) 360-8592

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1728950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1346060217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5013 N UNIVERSITY ST STE 2",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144796",
            "telephone_number": "309-693-2220",
            "fax_number": "309-693-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5013 N UNIVERSITY ST STE 2",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144796",
            "telephone_number": "309-693-2220",
            "fax_number": "309-693-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM E. CUSACK, D.D.S., LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-15",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A",
        "authorized_official_last_name": "CUSACK",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-360-8592"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann M Willemsen-Dunlap, CRNA
• Marion Willemsen-Reid, DO
• Kathleen Willerton
• Kate E Willhardt, APN
• Martha Joanne Willi, M.D.
• Leeann A Williammee
• Alyssa Williams Blake
• Felicia Williams-Triplett, RN
• Braden Williams, PA
• Charity Joy Williams, COTA

• Periodontics in Peoria, IL
• Providers in Peoria, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.