Bruce Edward Mathes, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

121 E Lake Ave
Ste G
Peoria, IL 61614-6182

Phone

(309) 685-2112

Fax

(309) 688-7393

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992893614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 E LAKE AVE",
            "address_2": "STE G",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616146182",
            "telephone_number": "309-685-2112",
            "fax_number": "309-688-7393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 E LAKE AVE",
            "address_2": "STE G",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616146182",
            "telephone_number": "309-685-2112",
            "fax_number": "309-688-7393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHES",
        "first_name": "BRUCE",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan L Mason, APN
• Vimal Master Sankar Raj, MD
• Trinity Hope Maston, LCPC
• Maternal Fetal Medicine Associates, S.C.
• Alexandra Mathern, M.D.
• Nevin Abraham Mathew, PMHNP-BC
• Maureen L. Mathews
• Mangayarkarasi Mathiyazhagan, DDS
• Jay L Mathur, MD
• Katherine A Mathus, PTA

• 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.