Roger Louis Paul, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1916423 Issued in IL

Practice address

521 W Lake Ave
Peoria, IL 61614-6020

Phone

(309) 682-0770

Fax

(309) 682-7285

NPI assigned

Nov 17, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Smalltown Dental River City PLLC

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1881543171
  NPD (past)

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497829063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 W LAKE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616146020",
            "telephone_number": "309-682-0770",
            "fax_number": "309-682-7285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 W LAKE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616146020",
            "telephone_number": "309-682-0770",
            "fax_number": "309-682-7285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAUL",
        "first_name": "ROGER",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "1916423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alisa Danielle Patterson
• Patti L Ally
• Robin Patton
• Natalie Patty
• Paul Schellenberg, LLC
• John Kevin Paulsen, M.D.
• Patrick Pautler
• James V. Pavlacic
• Amber D Pawula-Marcin, CNS, LDN
• Bryana Lynn Payne, LCPC

• 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 Jul 8, 2007; 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.