Smalltown Dental Glen LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SMALLTOWN DENTAL GLEN LLC

Practice address

2015 W Glen Ave Ste 230
Peoria, IL 61614-4691

Phone

(309) 673-4616

NPI assigned

Mar 4, 2021

Organization subpart

Yes

Parent organization

SMALLTOWN DENTAL MANAGEMENT LLCAs reported in NPPES

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

Authorized official

Name

Luke Overcash

Title

Operations Manager

Phone

(309) 370-5853

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shannon Havel, DDS

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1497646772
  NPD
• Turner Graham Reid, DDS

  • Dentist
  • Peoria, IL
  • NPI 1851961676
  NPD (past)
• David Lawrence Woodruff, D.D.S.

  • Dentist
  • Peoria, IL
  • NPI 1710149976
  NPD (past)

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1477148179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S 4TH AVE STE 110",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615503401",
            "telephone_number": "309-370-5853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 W GLEN AVE STE 230",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144691",
            "telephone_number": "309-673-4616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMALLTOWN DENTAL GLEN LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SMALLTOWN DENTAL MANAGEMENT LLC",
        "enumeration_date": "2021-03-04",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A",
        "authorized_official_last_name": "OVERCASH",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "309-370-5853"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Dawn Slaughter, APN
• Cierra Sledge, DMD
• Patrick Michel Sleiman, M.D.
• Sue Ann Slusher, COTA/L
• James R Smalley, MD
• Smalltown Dental Peoria LLC (Smalltown Dental Peoria)
• Smalltown Dental River City PLLC
• Smalltown Dental Willow Knolls LLC (Smalltown Dental Willow Knolls)
• Anna Carney Smarjesse
• Stephen J Smart, MD

• 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 Mar 4, 2021; 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.