Nizar N Merheb

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

021002096 Issued in IL

Practice address

11825 State Route 40
Dunlap, IL 61525-8842

Phone

(309) 243-8980

NPI assigned

Mar 9, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Nov 1, 2022 through Nov 1, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187913600000",
    "number": "1811028848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10705 N ALEX DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151167",
            "telephone_number": "309-868-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11825 STATE ROUTE 40",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "615258842",
            "telephone_number": "309-243-8980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERHEB",
        "first_name": "NIZAR",
        "middle_name": "N",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-09",
        "last_updated": "2007-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021002096",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "IL",
            "license": "036111888",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maple Shade Dental (Dunlap) LLC
• Maple Shade Dental Group
• Mapleshade Vision Center Inc.
• Kami Maurer, FNP
• Hilary A McEvoy, M.A.
• Mobile Diagnostic Services, Inc
• Prudence Barbara Mortoti, MCD, CCC-SLP
• Naby Nature'S Hand Inc
• Manish Patel
• Proctor Health Systems

• Oral and Maxillofacial Surgery (Dentist) in Dunlap, IL
• Providers in Dunlap, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.