James Miguel Covington, DDS
Individual provider Active NPI Dentist · Peru, IL
NPI 1548947815 · NPPES record last updated Jun 29, 2023
Key facts
- NPI
- 1548947815
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019034434 (IL)
- Practice address
- 5301 State Route 251 Ste a
Peru, IL 61354-9317 - Phone
- (779) 601-6065
- NPI assigned
- Jun 29, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019034434 | IL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019034434 | IL | Yes |
Addresses
Primary practice location
5301 State Route 251 Ste a
Peru, IL 61354-9317
Mailing address
11751 S Artesian Ave
Chicago, IL 60655-1515
Phone (773) 952-1716
Other providers in Peru, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.