Peoria Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PEORIA DENTAL LLC

Practice address

7417 N Knoxville Ave
Peoria, IL 61614-2019

Phone

(309) 981-5995

Fax

(309) 981-5981

NPI assigned

Apr 12, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Scott C Bares, DDS

Title

President

Phone

(309) 981-5995

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1523491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523491200000",
    "number": "1992202139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7417 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142019",
            "telephone_number": "309-981-5995",
            "fax_number": "309-981-5981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7417 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142019",
            "telephone_number": "309-981-5995",
            "fax_number": "309-981-5981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEORIA DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-12",
        "last_updated": "2018-04-12",
        "status": "A",
        "authorized_official_last_name": "BARES",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-981-5995",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peoria County Court Administration
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• Peoria County Rural Transportation
• Peoria Day Surgery Center LTD
• Peoria Dental Care
• Peoria Ear Nose and Throat Group SC
• Peoria Eye Clinic, LTD
• Peoria Family Chiropractic LLC
• Peoria Fire Department
• Peoria Hand Surgery, LLC

• Dental Clinic/Center in Peoria, IL
• Providers in Peoria, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; 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.