NPIMap

Organization Active NPI

Sikora & Jacobsen LLC

  • General Practice Dentistry
  • Bloomington, IL
National Provider Identifier
1629403167
Registry record updated Sep 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019.028635 Issued in IL
Legal business name
SIKORA & JACOBSEN LLC
Doing business as
Prairie Dental Associates
Practice address
3220 Gerig Dr
Bloomington, IL 61704-6394
Phone
(309) 662-7722
NPI assigned
Sep 3, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2013

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

Authorized official

Name
Daniel JacobsenNPI 1952688293
Title
Partner
Phone
(309) 662-7722

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019.028635 IL Primary

Addresses

Primary practice location

3220 Gerig Dr
Bloomington, IL 61704-6394

Mailing address

3220 Gerig Dr
Bloomington, IL 61704-6394
Phone (309) 662-7722

Other names 1

  • Prairie Dental Associates Doing business as

National Provider Directory

National Provider Directory

Locations

3220 Gerig Dr
Bloomington, IL 61704
Phone (309) 662-7722

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": "1378166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378166400000",
    "number": "1629403167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 GERIG DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046394",
            "telephone_number": "309-662-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 GERIG DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046394",
            "telephone_number": "309-662-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIKORA & JACOBSEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-03",
        "last_updated": "2013-09-03",
        "status": "A",
        "authorized_official_last_name": "JACOBSEN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "309-662-7722"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.028635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; 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.