Active NPI
Katherine A. Kuntz-Jakuc, D.D.S.
- Endodontics
- Peoria, IL
National Provider Identifier
1346579240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 019023996
- Practice address
- 6901 N Knoxville Ave
Suite 100
Peoria, IL 61614 - Phone
- (309) 691-3230
- Fax
- (309) 691-3250
- NPI assigned
- Dec 24, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 019023996 | IL | Primary |
Addresses
Primary practice location
6901 N Knoxville Ave
Suite 100
Peoria, IL 61614
Mailing address
6901 N Knoxville Ave
Suite 100
Peoria, IL 61614
Phone (309) 691-3230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019023996 | IL | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1261612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261612800000",
"number": "1346579240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6901 N KNOXVILLE AVE",
"address_2": "SUITE 100",
"city": "PEORIA",
"state": "IL",
"postal_code": "61614",
"telephone_number": "309-691-3230",
"fax_number": "309-691-3250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6901 N KNOXVILLE AVE",
"address_2": "SUITE 100",
"city": "PEORIA",
"state": "IL",
"postal_code": "61614",
"telephone_number": "309-691-3230",
"fax_number": "309-691-3250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUNTZ-JAKUC",
"first_name": "KATHERINE",
"middle_name": "A.",
"name_prefix": "Mrs.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-24",
"last_updated": "2009-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "IL",
"license": "019023996",
"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 Dec 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.