Peter Doran, DDS.
Individual provider Active NPI General Practice Dentistry · Mendota, IL
NPI 1659458602 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1659458602
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Practice address
- 1318 Meriden St
Mendota, IL 61342-1030 - Phone
- (815) 539-3000
- Fax
- (815) 539-3733
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
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 |
|---|---|---|---|
| 019-017180 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ernesto a Villalobos, DDS, Ms, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Yes |
Addresses
Primary practice location
1318 Meriden St
Mendota, IL 61342-1030
Mailing address
1318 Meriden St
Mendota, IL 61342-1030
Phone (815) 539-3000
Other providers in Mendota, IL
- City of Mendota
- Community Health Partnership of Illinois
- Davis Family Health LLC
- Kelly Ann Tonielli Davis
- Malorie Defore
- Paul Daniel Doyle
- Dr. Megan'S Healthcare Ministries LLC
- Franklin J Duro
- Hannah Eager
- Jonathan Edwards
All providers in Mendota, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.