Dental Sealants & More

Primary specialty

DentistTaxonomy code 122300000X

License

019-010639 Issued in IL

Legal business name

DENTAL SEALANTS & MORE

Practice address

2126 N. University St.
Peoria, IL 61604

Phone

(309) 339-4433

Fax

(309) 406-1326

NPI assigned

Mar 28, 2008

Last updated

Feb 8, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

DENTAL SEALANTS & MOREAs reported in NPPES

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

Authorized official

Name

Renee Katherine Dietz, DMD

Title

President

Phone

(309) 339-4433

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Dental Sealants More

Locations

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

{
    "created_epoch": "1206662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486512000000",
    "number": "1770755852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2126 N. UNIVERSITY ST.",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61604",
            "telephone_number": "309-339-4433",
            "fax_number": "309-406-1326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2126 N. UNIVERSITY ST.",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61604",
            "telephone_number": "309-339-4433",
            "fax_number": "309-406-1326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SEALANTS & MORE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL SEALANTS & MORE",
        "enumeration_date": "2008-03-28",
        "last_updated": "2017-02-08",
        "status": "A",
        "authorized_official_last_name": "DIETZ",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "KATHERINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-339-4433",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-010639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL DENTAL OF ILLINOIS",
            "identifier": "1001319",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evelyn P Denny
• Dental Arts Laboratories, Inc. (Midwest Dental Lab)
• Dental Professionals of Illinois, P.C. (Smile Design Dental Center)
• Dental Professionals of Illinois, P.C. (Peoria Family Dental Care)
• Dental Professionals of Illinois, P.C. (Northgate Family Dental)
• Heather L Dentino, APN
• Theresa Ann Denton, PTA
• Dentsensus Peoria, PLLC (Just Kidz Dentistry)
• Dentsensus, PLLC
• Marte Linn Deppermann, MD

• Dentist in Peoria, IL
• Providers in Peoria, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2017; 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.