Optim Dental Peoria-1 LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

OPTIM DENTAL PEORIA-1 LLC

Practice address

1200 W Main St Ste 9
Peoria, IL 61606-1218

Phone

(309) 777-9777

NPI assigned

Mar 20, 2017

Last updated

Mar 20, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Srinivas Durshanapalli, DDS

Title

President

Phone

(217) 303-5955

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Venkat Yashaswi Kondapalli

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1740704832
  NPD (past)
• Jai Krishna Srikanth Kolliboyana, DDS

  • General Practice Dentistry
  • San Angelo, TX
  • NPI 1194379271
  NPD (past)

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

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489968000000",
    "number": "1962943290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W MAIN ST STE 9",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061218",
            "telephone_number": "309-777-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W MAIN ST STE 9",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061218",
            "telephone_number": "309-777-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIM DENTAL PEORIA-1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-20",
        "last_updated": "2017-03-20",
        "status": "A",
        "authorized_official_last_name": "DURSHANAPALLI",
        "authorized_official_first_name": "SRINIVAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-303-5955",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angie Christine Onion
• Karla Ontiveros
• Sherin Oommen
• Chibuzor Nonye Opara, MD
• Jonathan Opperman, PT
• Oral & Maxillofacial Surgeons of Central Illinois
• Orland Park Dental Services
• Orland Park Orthopedics SC
• Stephen R Orlevitch, M.D.
• Andrew Joseph Ortega, 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 Mar 20, 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.