Individual provider Active NPI

Joachim Ajala, DMD

  • Dentist
  • Peoria, IL
National Provider Identifier
1619094166
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Practice address
7310 N Villa Lake Dr
Suite B
Peoria, IL 61614-8267
Phone
(309) 691-9072
Fax
(309) 691-9432
NPI assigned
Mar 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X IL Primary

Addresses

Primary practice location

7310 N Villa Lake Dr
Suite B
Peoria, IL 61614-8267

Mailing address

7310 N Villa Lake Dr
Suite B
Peoria, IL 61614-8267
Phone (309) 691-9072

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

LicenseStateTypeSpecialty
019026960ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifetime Dental Care of Illinois, PC Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619094166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7310 N VILLA LAKE DR",
            "address_2": "SUITE B",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148267",
            "telephone_number": "309-691-9072",
            "fax_number": "309-691-9432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7310 N VILLA LAKE DR",
            "address_2": "SUITE B",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148267",
            "telephone_number": "309-691-9072",
            "fax_number": "309-691-9432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJALA",
        "first_name": "JOACHIM",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "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 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.