Active NPI
Charles L. Proesel Jr., D.D.S.
- Public Health Dentistry
- Gridley, IL
National Provider Identifier
1972508364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health Dentistry
- License
- 19A14491
- Practice address
- 205 E Gridley Rd
Gridley, IL 61744-8733 - Phone
- (309) 747-2213
- Fax
- (309) 747-3989
- NPI assigned
- Jun 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health Dentistry | 1223D0001X | 19A14491 | IL | Primary |
Addresses
Primary practice location
205 E Gridley Rd
Gridley, IL 61744-8733
Mailing address
PO Box 288
Gridley, IL 61744-0288
Phone (309) 747-2213
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19A14491 | IL | MD | Public Health Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1972508364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 288",
"city": "GRIDLEY",
"state": "IL",
"postal_code": "617440288",
"telephone_number": "309-747-2213",
"fax_number": "309-747-3989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 E GRIDLEY RD",
"city": "GRIDLEY",
"state": "IL",
"postal_code": "617448733",
"telephone_number": "309-747-2213",
"fax_number": "309-747-3989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROESEL",
"first_name": "CHARLES",
"middle_name": "L.",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-14",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0001X",
"taxonomy_group": "",
"desc": "Dentist, Dental Public Health",
"state": "IL",
"license": "19A14491",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gridley, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.