Pine Glen Dental Group, LTD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PINE GLEN DENTAL GROUP, LTD

Practice address

838 W Glen Ave
Peoria, IL 61614-4835

Phone

(309) 691-1990

Fax

(309) 691-9112

NPI assigned

May 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Robert Michael Pollard, DDSNPI 1801004502

Title

President

Phone

(309) 691-1990

Specialties & licenses 1

Addresses

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Michael Pollard, DDS

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1801004502
  NPD (past) Authorized official
• Lori Anne Pollard Rice, DDS

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1063620771
  NPD (past)
• Eric Thomas Sudholt, D.M.D.

  • Dentist
  • Peoria, IL
  • NPI 1467759944
  NPD (past)

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659589299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "838 W GLEN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144835",
            "telephone_number": "309-691-1990",
            "fax_number": "309-691-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "838 W GLEN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144835",
            "telephone_number": "309-691-1990",
            "fax_number": "309-691-9112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE GLEN DENTAL GROUP, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POLLARD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-691-1990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa M Pierce, CPNP-AC
• Alexa Pieri, PA
• Evan C Pike, M.D.
• Joseph Daniel Pilon, APRN, FNP-BC
• Pine Glen Dental Group, LTD
• Pinnacle Anesthesia Consultants LLC
• Arun C Pinto, MD
• Rosemarie L. Piper, P.T.
• Stephanie M Piquard-Capranica
• Paranjyothy Rao Pirangi Sanjeeva, M.D.

• 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 Aug 22, 2020; 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.