NPIMap

Organization Active NPI

Total Dental Care LTD

  • Dentist
  • Pekin, IL
National Provider Identifier
1811079866
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
TOTAL DENTAL CARE LTD
Practice address
13 Olt Avenue
Pekin, IL 61554
Phone
(309) 347-7055
Fax
(309) 347-7383
NPI assigned
Oct 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Stephen Edward Dickey, DDSNPI 1972663607
Title
President Owner
Phone
(309) 347-7055

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 05915931 IL
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X IL Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X IL

Addresses

Primary practice location

13 Olt Avenue
Pekin, IL 61554

Mailing address

13 Olt Avenue
Pekin, IL 61554
Phone (309) 347-7055

National Provider Directory

National Provider Directory

Locations

13 Olt Ave
Pekin, IL 61554
Phone (309) 347-7055

Practitioners & affiliated clinicians

Practitioners 1

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": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811079866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 OLT AVENUE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "61554",
            "telephone_number": "309-347-7055",
            "fax_number": "309-347-7383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 OLT AVENUE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "61554",
            "telephone_number": "309-347-7055",
            "fax_number": "309-347-7383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL DENTAL CARE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DICKEY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "309-347-7055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "05915931",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pekin, IL

Sources for this page

  • 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.