NPIMap

Organization Active NPI

Affordable Dentures- Peoria, P.C

  • Dentist
  • Peoria, IL
National Provider Identifier
1477824977
Registry record updated Jan 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.018482 Issued in IL
Legal business name
AFFORDABLE DENTURES- PEORIA, P.C
Practice address
2807 W Townline Rd
Peoria, IL 61615-1557
Phone
(309) 689-1452
NPI assigned
Jan 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2012

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

Authorized official

Name
Dr. Paul D. Larsen, DDSNPI 1609955798
Title
Practice Owner
Phone
(309) 689-1452

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019.018482 IL Primary

Addresses

Primary practice location

2807 W Townline Rd
Peoria, IL 61615-1557

Mailing address

2807 W Townline Rd
Peoria, IL 61615-1557
Phone (309) 689-1452

National Provider Directory

National Provider Directory

Locations

2807 W Townline Rd
Peoria, IL 61615
Phone (309) 689-1452

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1326672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326672000000",
    "number": "1477824977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2807 W TOWNLINE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151557",
            "telephone_number": "309-689-1452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2807 W TOWNLINE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151557",
            "telephone_number": "309-689-1452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFORDABLE DENTURES- PEORIA, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-16",
        "last_updated": "2012-01-16",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "309-689-1452",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.018482",
            "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 16, 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.